NPIMap

Organization Active NPI

Grenada Lake Medical Center

  • General Acute Care Hospital
  • Grenada, MS
National Provider Identifier
1467781377
Registry record updated Dec 24, 2009
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 Avent Dr
Grenada, MS 38901-5230
Phone
(662) 227-7625
Fax
(662) 227-7534
NPI assigned
Dec 24, 2009
Last updated
Dec 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2009

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 Avent Dr
Grenada, MS 38901-5230

Mailing address

960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7625

Other identifiers 1

IdentifierTypeStateIssuer
03821032MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Grenada Lake Medical Ce3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1261612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261612800000",
    "number": "1467781377",
    "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": "662-227-7625",
            "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": "662-227-7625",
            "fax_number": "662-227-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-24",
        "last_updated": "2009-12-24",
        "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": "03821032",
            "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 Dec 24, 2009; 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.