GREENWOOD COMPREHENSIVE MEDICAL CLINIC NPI 1225172562

NPI Information

NPI: 1225172562
Provider Name: GREENWOOD COMPREHENSIVE MEDICAL CLINIC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 25D0691090

Address:
517 HIGHWAY 82 W
GREENWOOD, MS
ZIP 38930
Phone: (662) 455-6767
Get Directions

GREENWOOD COMPREHENSIVE MEDICAL CLINIC is a family medicine in Greenwood, MS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GREENWOOD COMPREHENSIVE MEDICAL CLINIC NPI is 1225172562. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

517 HIGHWAY 82 W
GREENWOOD, MS
ZIP 38930-030
Phone: (662) 455-6767
Fax: (662) 455-1774

The provider's authorized official is Valencia Patrice Martin .
The authorized official title is Vice President and has the following contact phone number (662) 455-6767.

The CLIA number assigned to this NPI record is 25D0691090 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 2/19/2007 and was last updated on 7/16/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	R853566	MISSISSIPPI	No
2	207R00000X	Internal Medicine		10035	MISSISSIPPI	No
3	363LF0000X	Nurse Practitioner	Family	R853204	MISSISSIPPI	No
4	363LF0000X	Nurse Practitioner	Family	R656461	MISSISSIPPI	No
5	207Q00000X	Family Medicine		10298	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	08327741	MEDICAID	MISSISSIPPI
2	080009985	MEDICARE PIN	MISSISSIPPI
3	302G705673	MEDICARE PIN	MISSISSIPPI
4	500000591	MEDICARE PIN	MISSISSIPPI
5	DR8830	MEDICARE PIN	MISSISSIPPI
6	P00241824	MEDICARE PIN	MISSISSIPPI
7	09015021	MEDICAID	MISSISSIPPI
8	P89690	MEDICARE UPIN	MISSISSIPPI
9	S29080	MEDICARE UPIN	MISSISSIPPI
10	110000141	MEDICARE PIN	MISSISSIPPI
11	P01044475	MEDICARE PIN	MISSISSIPPI
12	B30135	MEDICARE UPIN	MISSISSIPPI
13	00117378	MEDICAID	MISSISSIPPI
14	06785238	MEDICAID	MISSISSIPPI
15	080000269	MEDICARE PIN	MISSISSIPPI
16	B31095	MEDICARE UPIN	MISSISSIPPI
17	110016319	MEDICARE PIN	MISSISSIPPI
18	00016353	MEDICAID	MISSISSIPPI
19	00124524	MEDICAID	MISSISSIPPI
20	302I502986	MEDICARE PIN	MISSISSIPPI
21	302I507499	MEDICARE PIN	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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