Healthcare Provider Details

I. General information

NPI: 1689633950
Provider Name (Legal Business Name): GREENWOOD LEFLORE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E WASHINGTON ST
GREENWOOD MS
38930-4407
US

IV. Provider business mailing address

PO BOX 1410 ATTN: CLINIC ADMINISTRATION
GREENWOOD MS
38935-1410
US

V. Phone/Fax

Practice location:
  • Phone: 662-459-7000
  • Fax:
Mailing address:
  • Phone: 662-459-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY ADAMS
Title or Position: CEO
Credential:
Phone: 662-459-7000