MEDICARE: GREENWOOD UROLOGY CLINIC, P.A.

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	208800000X	Urology Physician

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	:	1003808882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD UROLOGY CLINIC, P.A.

Provider Business Mailing Address
First Line	:	205 8TH ST
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-4011
Country	:	US
Telephone Number	:	662-453-6732
Fax Number	:	662-453-6734

Provider Business Practice Location Address
First Line	:	205 8TH ST
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-4011
Country	:	US
Telephone Number	:	662-453-6732
Fax Number	:	662-453-6734

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES S ROBBINS III
Credential	:	M.D.
Telephone Number	:	662-453-6732

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	04/09/2010

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