Grenada Lake Medical Center
NPI 1053684548ActiveOrganization· Family Medicine· Grenada, MS
Family Medicine in Grenada, Mississippi, registered in NPPES in February 2012, part of Grenada Lake Medical Center. The authorized official on file is David G. Putt, FACHE, Ceo.
Overview
| NPI | 1053684548 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Grenada Lake Medical Center |
| NPI issued | Feb 15, 2012 |
| Last updated in NPPES | Mar 18, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 21836 | MS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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