NPIMap

Organization Active NPI

Grenada Lake Medical Center

  • General Acute Care Hospital
  • Grenada, MS
National Provider Identifier
1326109505
Registry record updated Aug 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
11-245 Issued in MS
Legal business name
GRENADA LAKE MEDICAL CENTER
Practice address
960 J K Avent Dr
Grenada, MS 38901
Phone
(662) 227-7000
Fax
(662) 227-6538
NPI assigned
Dec 12, 2006
Last updated
Aug 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2012

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

Authorized official

Name
Mr. Charles L Denton
Title
Ceo
Phone
(662) 227-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 11-245 MS Primary

Addresses

Primary practice location

960 J K Avent Dr
Grenada, MS 38901

Mailing address

960 J K Avent Dr
Grenada, MS 38901
Phone (662) 227-7000

Other identifiers 2

IdentifierTypeStateIssuer
09011014MedicaidMS
000019026OtherMSBX PROF FEE #

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344556800000",
    "number": "1326109505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 J K AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "38901",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-6538"
        },
        {
            "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": "38901",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-08-10",
        "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": "662-227-7000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "11-245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09011014",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BX PROF FEE #",
            "identifier": "000019026",
            "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 10, 2012; 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.