Healthcare Provider Details

I. General information

NPI: 1508145855
Provider Name (Legal Business Name): GREENWOOD LEFLORE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W WASHINGTON ST
GREENWOOD MS
38930
US

IV. Provider business mailing address

PO BOX 1410
GREENWOOD MS
38935-1410
US

V. Phone/Fax

Practice location:
  • Phone: 662-453-4641
  • Fax:
Mailing address:
  • Phone: 662-453-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWNE HOLMES
Title or Position: CFO
Credential:
Phone: 662-459-7119