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General NPI Number Information
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NPI Number | 1790174993
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Entity Type | Organization
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Legal Business Name | SCOTT GRIGORY, MD, PC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 1 W MAIN ST SUITE 100
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City | IDABEL
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State | OK
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Zip | 74745-4654
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Country | US
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Telephone | 580-579-3385
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W MAIN ST SUITE 100
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City | IDABEL
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State | OK
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Zip | 74745-4654
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Country | US
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Telephone | 580-579-3385
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT MARTIN GRIGORY
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Credential | M.D.
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Telephone | 580-579-3385
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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 | 25241
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25241
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25241
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License Number State | OK
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