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GRENADA PRIMARY CARE CLINIC
NPI 1154506277
Clinic/Center - Rural Health in Grenada, MS

Active since January 08, 2008
965 AVENT DR STE 105, GRENADA, MS 38901(662) 227-7575 Get Directions Write a Review

NPPES record last updated: January 8, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Grenada Primary Care Clinic NPPES

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

GRENADA PRIMARY CARE CLINIC (NPI 1154506277) is a healthcare organization registered as a rural health in Grenada, Mississippi and active in the NPI registry since January 2008. The organization lists Charles L Denton, Ceo, as its authorized official.

NPPES Registry Identity

NPI1154506277
Entity TypeOrganization
Primary Taxonomy261QR1300X
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) 227-7005
Enumeration DateJanuary 8, 2008
✔ NPI 1154506277 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
License✔ Licensed in MS · 11-245
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
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 1154506277. It was assigned to this organization in the NPPES registry on January 8, 2008. 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, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for Grenada Lake Medical Center was last updated on January 8, 2008. 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.