GRENADA PRIMARY CARE CLINIC
NPI 1134302136
Clinic/Center in Grenada, MS

Q: What is Grenada Lake Medical Center's NPI number?

The NPI number for Grenada Lake Medical Center is 1134302136. It was assigned to this organization in the NPPES registry on December 12, 2007. The provider is doing business as Grenada Primary Care Clinic.

Q: What is Grenada Lake Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since December 12, 2007

965 AVENT DR STE 105, GRENADA, MS 38901(662) 227-7575 Get Directions Write a Review

NPPES record last updated: December 17, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Grenada Primary Care Clinic NPPES

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

GRENADA PRIMARY CARE CLINIC (NPI 1134302136) is a healthcare organization registered as a clinic/center in Grenada, Mississippi and active in the NPI registry since December 2007. The organization lists Charles L Denton, Ceo, as its authorized official.

NPPES Registry Identity

NPI1134302136

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameGRENADA LAKE MEDICAL CENTER

Location Address965 AVENT DR STE 105Grenada, MS 38901-5045

Mailing Address965 Avent Dr Ste 105Grenada, MS 38901-5045 · (662) 227-7575

Phone(662) 227-7575

Organization SubpartNo

Authorized OfficialCharles L DentonCeo · (662) 227-7000

Enumeration DateDecember 12, 2007

Last NPPES UpdateDecember 17, 2007

✔ NPI 1134302136 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

License✔ Licensed in MS · 11-245

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X · License 11-245 (MS)

965 AVENT DR STE 105, Grenada, MS 38901

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Other Names 1

Doing Business AsGrenada Primary Care Clinic

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GRENADA LAKE MEDICAL CENTER

Clinic/Center (Rural Health)

965 AVENT DR STE 105
GRENADA, MS 38901

Grenada County (662) 227-7575

MS. CYNTHIA C DOTSON NP

Nurse Practitioner (Family)

965 AVENT DR STE 105
GRENADA, MS 38901

Grenada County (662) 227-7575

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 1134302136. It was assigned to this organization in the NPPES registry on December 12, 2007. The provider is doing business as Grenada Primary Care Clinic.

Where is Grenada Lake Medical Center located?

Grenada Lake Medical Center is located at 965 Avent Dr Ste 105, Grenada, MS 38901. The listed phone number is (662) 227-7575.

What is Grenada Lake Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Grenada Lake Medical Center was last updated on December 17, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.