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GRENADA SPECIALTY CLINIC - TERRY PUMMER
NPI 1053684548
Family Medicine in Grenada, MS

Active since February 15, 2012
965 AVENT DR STE 100A, GRENADA, MS 38901(662) 227-7444(662) 227-7443 Get Directions Write a Review

NPPES record last updated: March 18, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Grenada Specialty Clinic - Terry Pummer NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRENADA SPECIALTY CLINIC - TERRY PUMMER (NPI 1053684548) is a healthcare organization registered as a family medicine in Grenada, Mississippi and active in the NPI registry since February 2012. The organization lists David G. Putt, Ceo, as its authorized official.

NPPES Registry Identity

NPI1053684548
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameGRENADA LAKE MEDICAL CENTER
Location Address965 AVENT DR STE 100AGrenada, MS 38901-5045
Mailing Address965 Avent Dr Ste 100aGrenada, MS 38901-5045 · (662) 227-7444 · Fax (662) 227-7443
Phone(662) 227-7444
Fax(662) 227-7443
Organization SubpartYes
Authorized OfficialDavid G. PuttCeo · (662) 227-7000
Enumeration DateFebruary 15, 2012
Last NPPES UpdateMarch 18, 2014
✔ NPI 1053684548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MS · 21836
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
965 AVENT DR STE 100A, Grenada, MS 38901
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Other Names 1

Doing Business AsGrenada Specialty Clinic - Terry Pummer

Other Identifiers 3

Medicaid00059747MS
Medicare PIN258969YK3UMS
Other11516802MS · Caqh

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grenada Lake Medical Center's NPI number?

The NPI number for Grenada Lake Medical Center is 1053684548. It was assigned to this organization in the NPPES registry on February 15, 2012. The provider is doing business as Grenada Specialty Clinic - Terry Pummer.

Where is Grenada Lake Medical Center located?

Grenada Lake Medical Center is located at 965 Avent Dr Ste 100A, Grenada, MS 38901. The listed phone number is (662) 227-7444.

What is Grenada Lake Medical Center's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Grenada Lake Medical Center was last updated on March 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.