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NPI Code Detail

MEDICARE: DIAMOND GROVE CENTER

MEDICARE: DIAMOND GROVE CENTER
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
13336I0012XInstitutional Pharmacy03665MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100020375OTHERMSBLUE CROSS PROVIDER #
200330450OTHERMSDIAMOND GROVE CENTER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619000593
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND GROVE CENTER
Provider Business Mailing Address
First Line : 2311 HIGHWAY 15 S
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-7071
Country : US
Telephone Number : 662-779-0119
Fax Number : 662-779-0126
Provider Business Practice Location Address
First Line : 2311 HIGHWAY 15 S
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-7071
Country : US
Telephone Number : 662-779-0119
Fax Number : 662-779-0126
Authorized Official
Title or Position : ADMINISTRATOR
Name : PATRICK SWOOPES
Credential :
Telephone Number : 662-779-0119
Provider Enumeration Date : 03/13/2007
Last Update Date : 12/13/2007

Similar Medicare Providers

1558372193 — DIAMOND GROVE CTR PHARMACY
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
Practice Phone: 662-779-0119
Practice Fax: 662-779-0126
1447350160 — DIAMOND GROVE CENTER
Practice Location Address:
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1801967674 — DR. KENNETH E PERES MD
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
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Practice Fax:
1659404572 — DIAMOND GROVE CENTER
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
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Practice Fax: 662-779-0126
1770617086 — DIAMOND GROVE CENTER
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
Practice Phone: 662-779-0119
Practice Fax: 662-779-0126
1861359341 — LOCALMED URGENT CARE, LLC
Practice Location Address:
180 BALL DR
LOUISVILLE, MS
39339
Practice Phone: 662-736-9123
Practice Fax: 662-736-9124

Directions to “DIAMOND GROVE CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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