Grenada Lake Medical Center

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

11245 Issued in MS

Legal business name

GRENADA LAKE MEDICAL CENTER

Practice address

960 Avent Dr
Grenada, MS 38901-5230

Phone

(662) 227-7000

Fax

(662) 227-7534

NPI assigned

Feb 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles L Denton

Title

Ceo

Phone

(662) 227-7005

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Grenada Lake Medical Center DME

  • Durable Medical Equipment & Medical Supplies
  • Grenada, MS
  • NPI 1295700011

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1144295965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015230",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015230",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "DENTON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-227-7005"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "11245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00070502",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grenada Hematology Oncology LLC
• Grenada Lake Inpatient Medicine Associates
• Grenada Lake Medical Center
• Grenada Lake Medical Center (Grenada Specialty Clinic - Terry Pummer)
• Grenada Lake Medical Center (Grenada Primary Care Clinic)
• Grenada Lake Medical Center (Grenada Primary Care Clinic)
• Grenada Lake Medical Center (Parkwood Pavilion at Grenada)
• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center

• Home Health Agency in Grenada, MS
• Providers in Grenada, MS by specialty
• Home Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.