Grenada Lake Inpatient Medicine Associates

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GRENADA LAKE INPATIENT MEDICINE ASSOCIATES

Practice address

960 J K Avent Dr
Grenada, MS 38901-5230

Phone

(662) 227-7492

Fax

(662) 227-7541

NPI assigned

Jan 24, 2007

Organization subpart

No

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

Authorized official

Name

Keith Heartsill

Title

Cfo

Phone

(662) 227-7172

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1235284928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52007",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303550007",
            "telephone_number": "678-397-0060",
            "fax_number": "678-397-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 J K AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015230",
            "telephone_number": "662-227-7492",
            "fax_number": "662-227-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE INPATIENT MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "HEARTSILL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-227-7172"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grenada Diagnostic Sleep Center, LLC
• Grenada Emergency Group, LLC
• Grenada Family Chiropractic Inc
• Grenada Family Medicine Clinic
• Grenada Hematology Oncology LLC
• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center

• Internal Medicine Physician in Grenada, MS
• Providers in Grenada, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.