Provider Demographics
NPI:1861670911
Name:GREENWOOD LEFLORE HOSPITAL
Entity Type:Organization
Organization Name:GREENWOOD LEFLORE HOSPITAL
Other - Org Name:GLH PRO FEES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DAWNE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-459-2603
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1410
Mailing Address - Country:US
Mailing Address - Phone:662-459-2604
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVER RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4030
Practice Address - Country:US
Practice Address - Phone:662-459-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENWOOD LEFLORE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS930264305Medicare PIN
MS081261692Medicare PIN
MS081260193Medicare PIN
MS080260233Medicare PIN
MS060000376Medicare PIN
MSC00054Medicare PIN
MS080260233Medicare PIN
MS09013096Medicaid
MS00013505Medicaid
MS000121529Medicaid
MSC00054Medicare PIN
MS060000376Medicare PIN