National Provider Identifier Database

GRENADA LAKE MEDICAL CENTER
Rural


Contact Information

GRENADA LAKE MEDICAL CENTER
960 AVENT DR
GRENADA, MS38901-5230
Phone: 662-227-7000
Fax: 662-227-7534
Website:
Specialty Taxonomy Code
* Rural 282NR1301X

* Indicates primary specialty

NPI Profile & details for GRENADA LAKE MEDICAL CENTER

NPI Number 1386644789
Legal business name
LBN
GRENADA LAKE MEDICAL CENTER
Authorized official CHARLES DENTON - (CEO)
Entity Organization
Organization subpart No
Enumeration date 07/28/2005
Last updated 06/15/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • MS License #: 11245

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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