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General NPI Number Information
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NPI Number | 1245054212
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Entity Type | Organization
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Legal Business Name | PROMED PREFERRED TX 3 PLLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 100 S BOIS D ARC ST
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City | GRANDVIEW
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State | TX
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Zip | 76050-2208
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Country | US
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Telephone | 615-499-3165
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Fax |
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Provider Business Mailing Address
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Address Line | 329 S OYSTER BAY RD STE 2059
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City | PLAINVIEW
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State | NY
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Zip | 11803-3301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEV GRINMAN
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Credential | MD
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Telephone | 615-499-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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