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General NPI Number Information
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NPI Number | 1285047688
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Entity Type | Organization
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Legal Business Name | GRAND PRAIRIE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 1012 E 22ND ST
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City | STUTTGART
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State | AR
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Zip | 72160-6825
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Country | US
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Telephone | 870-672-0911
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Fax | 870-672-0914
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Provider Business Mailing Address
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Address Line | 1012 E 22ND ST
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City | STUTTGART
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State | AR
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Zip | 72160-6825
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Country | US
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Telephone | 870-672-0911
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Fax | 870-672-0914
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | CANDICE SMITH
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Credential |
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Telephone | 903-791-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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