Organization
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
UMMC Grenda Specialty Peds
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT WHITTEMORE (CFO GRENADA/HOLMES COUNTY)
(662) 227-7172
Entity
Organization
Contact information
Practice address
965 AVENT DR STE 100B, GRENADA, MS 38901-5045
(662) 227-7172
Mailing address
965 AVENT DR STE 100B, GRENADA, MS 38901-5045
(662) 227-7172
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
282NR1301X
Rural Acute Care Hospital
—
—
Other
Enumeration date
09/21/2016
Last updated
09/18/2018
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