Provider Demographics
NPI:1003808882
Name:GREENWOOD UROLOGY CLINIC, P.A.
Entity Type:Organization
Organization Name:GREENWOOD UROLOGY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-6732
Mailing Address - Street 1:205 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4011
Mailing Address - Country:US
Mailing Address - Phone:662-453-6732
Mailing Address - Fax:662-453-6734
Practice Address - Street 1:205 8TH ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4011
Practice Address - Country:US
Practice Address - Phone:662-453-6732
Practice Address - Fax:662-453-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04371729Medicaid
MS0664130001Medicare NSC
MS04371729Medicaid