1336109578 NPI number — GREENWOOD LEFLORE HOSPITAL

Table of content: (NPI 1336109578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336109578 NPI number — GREENWOOD LEFLORE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD LEFLORE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336109578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38935-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-459-7189
Provider Business Mailing Address Fax Number:
662-451-7812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-451-7812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
DAWNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
662-459-7119

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE4415 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 05683064 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com