Organization
GRENADA LAKE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES L DENTON (CEO)
(662) 227-7000
Entity
Organization
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
(662) 227-7534
Mailing address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
(662) 227-7534
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
11-245
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00050795
—
MS
Enumeration date
12/31/2009
Last updated
12/31/2009
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