GRENADA LAKE MEDICAL CENTER (NPI# 1386644789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386644789 |
| Entity Type | Organization |
| Organization Name | GRENADA LAKE MEDICAL CENTER |
| Practice Address |
960 Avent Dr Grenada MS 38901-5230 |
| Practice Telephone | 6622277000 |
| Practice Fax Number | 6622277534 |
| Mailing Telephone | 6622277000 |
| Mailing Fax Number | 6622277534 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2012-06-15 |
| Authorized Official Name | CHARLES L DENTON (CEO) |
| Authorized Official Telephone | 6622277000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NR1301X |
General Acute Care Hospital Specialization: Rural |
11245 | MS | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053684548 | Grenada Lake Medical Center | Family Medicine | 965 Avent Dr Ste 100a, Grenada, MS 38901-5045 | 2012-02-15 |
| 1922187095 | Grenada Lake Medical Center | Orthopaedic Surgery | 960 J K Avent Dr, Grenada, MS 38901-5230 | 2006-11-02 |
| 1699005355 | Grenada Lake Medical Center | Ambulance | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-12-31 |
| 1467781377 | Grenada Lake Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-12-24 |
| 1215165642 | Grenada Lake Medical Center | Psychiatric Unit | 960 Avent Dr, Grenada, MS 38901-5230 | 2009-06-24 |
| 1154506277 | Grenada Lake Medical Center | Clinic/Center | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2008-01-08 |
| 1134302136 | Grenada Lake Medical Center | General Acute Care Hospital | 965 Avent Dr Ste 105, Grenada, MS 38901-5045 | 2007-12-12 |
| 1790849354 | Grenada Lake Medical Center | General Acute Care Hospital | 960 J K Avent Dr, Grenada, MS 38901 | 2006-12-20 |
| 1326109505 | Grenada Lake Medical Center | General Acute Care Hospital | 960 J K Avent Dr, Grenada, MS 38901 | 2006-12-12 |
| 1669578894 | Grenada Lake Medical Center | Obstetrics & Gynecology | 1900 Grandview Dr, Grenada, MS 38901-5066 | 2006-09-15 |
| Street Address |
960 AVENT DR |
| City | GRENADA |
| State | MS |
| Zip Code | 38901-5230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003431602 | State of Mississippi - University of Mississippi Medical Center | Medicare Defined Swing Bed Unit | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-06-10 |
| 1356961320 | Angelina Guilambo | Physical Therapist | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-04-20 |
| 1841822152 | Shelby Helen Phelon Jackson | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2020-02-05 |
| 1194388082 | Grenada Emergency Group, LLC | Physician Assistant | 960 Avent Dr, Grenada, MS 38901-5230 | 2019-04-17 |
| 1932762721 | Grenada Physician Services, LLC | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2019-04-17 |
| 1013489319 | Kelsey Marter Moncrief | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2018-12-26 |
| 1760908321 | Linda Gail Carter | Nurse Practitioner | 960 Avent Dr, Grenada, MS 38901-5230 | 2017-08-16 |
| 1528463486 | Marionette Yarbrough | Physical Therapist | 960 Avent Dr, Grenada, MS 38901-5230 | 2014-11-04 |
| 1720419583 | State of Mississippi-university of Mississippi Medical Center | General Acute Care Hospital | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-12-04 |
| 1639500499 | State of Mississippi-university of Mississippi Medical Center | Durable Medical Equipment & Medical Supplies | 960 Avent Dr, Grenada, MS 38901-5230 | 2013-12-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902435118 | The Mane Physician | Prosthetic/Orthotic Supplier | 94 Spain Drive, Grenada, MS 38901 | 2020-04-08 |
| 1942842166 | Sylvia C Bass | Technician | 813 Union Street, Grenada, MS 38901 | 2019-10-09 |
| 1669971180 | Jenny Taylor | Nurse Practitioner | 350 Sunset Drive, Grenada, MS 38901 | 2018-02-10 |
| 1073912762 | John Thomas Mcree I | Counselor | 2026 Commerce St Ste 8e, Grenada, MS 38901 | 2014-08-19 |
| 1700213634 | State of Mississippi-university of Mississippi Medical Center | Home Health | 960 Avent Drive, Grenada, MS 38901 | 2013-10-10 |
| 1114359866 | Cmhp Enterprises | Dentist | 1420 Wooded Drive, Grenada, MS 38901 | 2013-08-05 |
| 1518256460 | Mercy Hospice LLC | Hospice Care, Community Based | 1410 Wooded Drive, Grenada, MS 38901 | 2011-03-31 |
| 1215256318 | Della Lea Welsh | Speech-Language Pathologist | 1321 Dd Sunset Dr., Grenada, MS 38901 | 2010-05-28 |
| 1750514543 | Family Health Care Clinic, Inc. | Clinic/Center | 1102 Telegraph St, Grenada, MS 38901 | 2009-08-27 |
| 1033384771 | Jason K Bennett | Pharmacist | 140 Shadow Wood Cv, Grenada, MS 38901 | 2008-04-24 |
| Find all providers in zip 38901 | ||||
| Taxonomy Code | 282NR1301X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Rural |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578011417 | State of Mississippi-university of Mississippi Medical Center | General Acute Care Hospital | 965 Avent Dr Ste 100b, Grenada, MS 38901-5045 | 2016-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043452493 | Stone County Hospital, Inc | General Acute Care Hospital | 1434 E Central Ave., Wiggins, MS 39577 | 2009-04-01 |
| 1245400423 | Stefanie Patterson Dendy | General Acute Care Hospital | 825 Grand Avenue, Yazoo City, MS 39194 | 2008-03-04 |
| 1154310514 | Oktibbeha County Hospital | General Acute Care Hospital | 400 Hospital Rd, Starkville, MS 39759-2163 | 2005-10-18 |
| 1578564712 | Picayune Clinic LLC | General Acute Care Hospital | 801 Goodyear Blvd, Picayune, MS 39466-3221 | 2005-08-10 |
| 1265683775 | Clay County Medical | General Acute Care Hospital | 835 Medical Center Dr, West Point, MS 39773-9320 | 2008-10-02 |
| 1053576819 | Leake Memorial Medical Clinic Walnut Grove | General Acute Care Hospital | 110 Park St, Walnut Grove, MS 39189-6526 | 2008-07-22 |
| 1306921887 | Delta Regional Medical Center | General Acute Care Hospital | 1400 E Union St, Greenville, MS 38703-3246 | 2006-10-25 |
| 1083637904 | Marion General Hospital | General Acute Care Hospital | 1560 Sumrall Rd, Columbia, MS 39429-2654 | 2006-07-25 |
| 1093752602 | George County Hospital- Erp | General Acute Care Hospital | 859 Winter St, Lucedale, MS 39452-6603 | 2006-06-01 |
| 1982641593 | George County Hospital- Crna | General Acute Care Hospital | 859 Winter St, Lucedale, MS 39452-6603 | 2006-06-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.