Active NPI
The Greenville Clinic
- Multi-Specialty Clinic/Center
- Greenville, MS
National Provider Identifier
1003844978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- THE GREENVILLE CLINIC
- Practice address
- 1502 S Colorado St
Greenville, MS 38703-7219 - Phone
- (662) 332-9872
- Fax
- (662) 332-9878
- NPI assigned
- Jun 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Regina E Spratlin
- Title
- Administrator
- Phone
- (662) 379-8104
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Medicine Physician | 207U00000X | |||
| Diagnostic Radiology Physician | 2085R0202X | |||
| Vascular Specialist/Technologist Cardiovascular | 246XC2903X | |||
| Bone Densitometry Radiologic Technologist | 2471B0102X | |||
| Computed Tomography Radiologic Technologist | 2471C3401X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Primary | ||
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
1502 S Colorado St
Greenville, MS 38703-7219
Mailing address
1502 S Colorado St
Greenville, MS 38703-7219
Phone (662) 332-9872
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2500316731 | Other | MS | CLIA |
| 9014413 | Medicaid | MS | |
| CD3504 | Other | MS | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040723000268 | MS | Part B Supplier - Clinic/Group Practice | 4082694641 |
Receives reassigned benefits from 10 practitioners Practice locations: Greenville, MS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Greenville, MS
- NPI 1245309418
-
- Pediatric Nurse Practitioner
- Greenville, MS
- NPI 1144966375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772409600000",
"number": "1003844978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1502 S COLORADO ST",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387037219",
"telephone_number": "662-332-9872",
"fax_number": "662-332-9878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1502 S COLORADO ST",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387037219",
"telephone_number": "662-332-9872",
"fax_number": "662-332-9878"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE GREENVILLE CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-29",
"last_updated": "2026-03-02",
"certification_date": "2026-03-02",
"status": "A",
"authorized_official_last_name": "SPRATLIN",
"authorized_official_first_name": "REGINA",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "662-379-8104"
},
"taxonomies": [
{
"code": "207U00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nuclear Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "246XC2903X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist/Technologist Cardiovascular, Vascular Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2471B0102X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiologic Technologist, Bone Densitometry",
"state": null,
"license": null,
"primary": false
},
{
"code": "2471C3401X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiologic Technologist, Computed Tomography",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "2500316731",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9014413",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CD3504",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.