Grenada Lake Medical Center

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

GRENADA LAKE MEDICAL CENTER

Doing business as

Grenada Specialty Clinic (GSC)

Practice address

960 J K Avent Dr
Grenada, MS 38901-5230

Phone

(662) 227-7000

Fax

(662) 227-7534

NPI assigned

Nov 2, 2006

Last updated

Mar 4, 2011By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• Grenada Specialty Clinic (GSC) Doing business as

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1922187095",
    "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": "389015230",
            "telephone_number": "662-227-7000",
            "fax_number": "662-227-7534"
        },
        {
            "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": "662-227-7000",
            "fax_number": "662-227-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2011-03-04",
        "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": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04557869",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "C03391",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grenada Specialty Clinic (GSC)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center (Grenada Women's Services)
• Grenada Lake Medical Center
• Grenada Lake Medical Center
• Grenada Lake Medical Center DME
• Grenada Pharmnet
• Grenada Physical Therapy, Inc
• Grenada Physician Services, LLC
• Grenada Rehabilitation and Healthcare Center, LLC

• Orthopaedic Surgery Physician in Grenada, MS
• Providers in Grenada, MS by specialty
• Orthopaedic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; 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.