Provider Demographics
NPI:1942439518
Name:BOONEVILLE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:BOONEVILLE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-720-3000
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0788
Mailing Address - Country:US
Mailing Address - Phone:662-720-3000
Mailing Address - Fax:662-720-3069
Practice Address - Street 1:100 HOSPITAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3354
Practice Address - Country:US
Practice Address - Phone:662-720-3000
Practice Address - Fax:662-720-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-04
Last Update Date:2009-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty