MEDICARE: GREENWOOD LEFLORE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841250172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD LEFLORE HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1410
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38935-1410
Country	:	US
Telephone Number	:	662-834-1855
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 TCHULA ST
Second Line	:
City	:	LEXINGTON
State	:	MS
Zip	:	39095-3111
Country	:	US
Telephone Number	:	662-834-1855
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JENNIFER DAWNE HOLMES
Credential	:
Telephone Number	:	662-459-2603

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/07/2018

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