Grenada Lake Medical Center
NPI 1053684548 · Family Medicine Physician · Grenada, MS
Grenada Lake Medical Center is a Family Medicine Physician organization in Grenada, MS (NPI 1053684548).
Provider details
- NPI number
- 1053684548
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Grenada Lake Medical Center
- Organization subpart
- Yes
- Authorized official
- David Putt, Ceo(662) 227-7000
- License
- 21836 (MS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Grenada Specialty Clinic - Terry Pummer
Registry dates
- Enumerated
- 2012-02-15
- Last updated
- 2014-03-18
Frequently asked questions
- What is Grenada Lake Medical Center's NPI number?
- Grenada Lake Medical Center's National Provider Identifier (NPI) is 1053684548, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Grenada Lake Medical Center?
- Grenada Lake Medical Center is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Grenada Lake Medical Center located?
- Grenada Lake Medical Center's practice location on file with NPPES is 965 Avent Dr Ste 100a, Grenada, MS 38901-5045.
- What is Grenada Lake Medical Center's phone number?
- The practice phone number listed in the NPPES registry for Grenada Lake Medical Center is (662) 227-7444.
- Who is the authorized official for Grenada Lake Medical Center?
- The authorized official listed on Grenada Lake Medical Center's NPPES record is David Putt, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Grenada Lake Medical Center's NPI active?
- Yes — Grenada Lake Medical Center's NPI (1053684548) is active in the NPPES registry as of the last update on 2014-03-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.