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Organization Active NPI

Greenwood Leflore Hospital

  • Rural Health Clinic/Center
  • Greenwood, MS
National Provider Identifier
1457587610
Registry record updated Jun 24, 2020
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Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREENWOOD LEFLORE HOSPITAL
Practice address
1601 Strong Ave
Greenwood, MS 38930-4037
Phone
(662) 451-7565
NPI assigned
Jun 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
Dawne Holmes
Title
Cfo
Phone
(662) 459-2603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1601 Strong Ave
Greenwood, MS 38930-4037

Mailing address

PO Box 1410
Greenwood, MS 38935-1410
Phone (662) 459-7565

Other identifiers 1

IdentifierTypeStateIssuer
05281500MedicaidMS

Other names 1

  • After Hours Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090901000339 MS Part A Provider - Rural Health Clinic 1153399472 Practice locations: Greenwood, MS

Rural health clinic certification: CCN 258555

Legal name
GREENWOOD LEFLORE HOSPITAL
Doing business as
AFTER HOURS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 28, 2010
Last certification
Nov 14, 2023
Ownership / control type
2A
Organization structure
GovernmentNon-profit
Enrollment address
1601 Strong Ave
After Hours Clinic
Greenwood, MS 38930-4037
Related CCNs
250099

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Greenwood Leflore Hospital Organization, Greenwood, MS Non-profit 5% Or Greater Direct Ownership Interest Jun 10, 2009 100%
Operational/Managerial Control Jun 10, 2009 100%
Harris Powers Individual Corporate DirectorBoard Chairman Sep 18, 2018
Marcus Banks Individual Corporate DirectorBoard Member Sep 18, 2018
City of Greenwood Organization, Greenwood, MS 5% Or Greater Indirect Ownership Interest Jun 10, 2009 50%
Leflore County Board of Supervisors Organization, Greenwood, MS 5% Or Greater Indirect Ownership Interest Jun 10, 2009 50%
Henry Hargrove Individual Corporate DirectorBoard Member Jun 1, 2019
Emma Bell Individual Corporate DirectorBoard Secretary/Treasurer Sep 18, 2018
Freddie White-Johnson Individual Corporate DirectorBoard Vice Chair Dec 1, 2016
Jennifer Dawne Holmes Individual Corporate OfficerCfo Oct 26, 2009
W-2 Managing EmployeeCfo Oct 26, 2009
Operational/Managerial ControlCfo Oct 26, 2009

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Itta Bena ClinicItta Bena, MS, CCN 253418 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 23, 2006

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1457587610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1410",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389351410",
            "telephone_number": "662-459-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 STRONG AVE",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389304037",
            "telephone_number": "662-451-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD LEFLORE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "DAWNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-459-2603"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05281500",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "After Hours Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "After Hours Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, MS

Sources for this page

Verify at the official NPI Registry.