Organization
DIAMOND GROVE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK SWOOPES (ADMINISTRATOR)
(662) 779-0119
Entity
Organization
Contact information
Practice address
2311 HIGHWAY 15 S, LOUISVILLE, MS 39339-7071
(662) 779-0119
(662) 779-0126
Mailing address
2311 HIGHWAY 15 S, LOUISVILLE, MS 39339-7071
(662) 779-0119
(662) 779-0126
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
03665
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020375
BLUE CROSS PROVIDER #
MS
05
—
00220411
—
MS
05
—
00220801
—
MS
01
—
00330450
DIAMOND GROVE CENTER
MS
Enumeration date
03/13/2007
Last updated
12/13/2007
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