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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
12084P0800XPsychiatry Physician

Other Identifiers

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

General Provider Information

NPI Number : 1770617086
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND GROVE CENTER
Provider Business Mailing Address
First Line : PO BOX 848
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-0848
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 : BUSINESS OFFICE DIRECTOR
Name : BRENDA SMITH
Credential :
Telephone Number : 601-581-9906
Provider Enumeration Date : 03/16/2007
Last Update Date : 08/22/2020

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:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
Practice Phone: 662-779-0119
Practice Fax: 662-779-0126
1801967674 — DR. KENNETH E PERES MD
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
Practice Phone: 662-779-0119
Practice Fax:
1659404572 — DIAMOND GROVE CENTER
Practice Location Address:
2311 HIGHWAY 15 S
LOUISVILLE, MS
39339-7071
Practice Phone: 662-779-0119
Practice Fax: 662-779-0126
1619000593 — 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

Language Start Address Practice Location
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