NPIMap

Organization Active NPI

Grenada Clinic for Women, PA

  • Obstetrics & Gynecology Physician
  • Grenada, MS
National Provider Identifier
1184644007
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
GRENADA CLINIC FOR WOMEN, PA
Practice address
1900 Grandview Dr
Grenada, MS 38901-5066
Phone
(662) 226-5121
Fax
(662) 226-7529
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas Holden, MD
Title
President
Phone
(662) 226-5121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1900 Grandview Dr
Grenada, MS 38901-5066

Mailing address

1900 Grandview Dr
Grenada, MS 38901-5066
Phone (662) 226-5121

Other identifiers 1

IdentifierTypeStateIssuer
09014147MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184644007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 GRANDVIEW DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015066",
            "telephone_number": "662-226-5121",
            "fax_number": "662-226-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GRANDVIEW DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015066",
            "telephone_number": "662-226-5121",
            "fax_number": "662-226-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA CLINIC FOR WOMEN, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLDEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-226-5121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014147",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grenada, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.