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1245200971

NPI Code Detail

MEDICARE: DR. KIM GRAVES M.D.

MEDICARE: DR. KIM GRAVES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C6829	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	080078696	OTHER	AR	RAILROAD MEDICARE/PALMETT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5306124	OTHER	AR	AETNA INSURANCE COMPANY
2	020407900	OTHER	AR	BLACK LUNG PROGRAM
3	0790780001	OTHER	AR	PALMETTO GBA
4	401067	OTHER	AR	HEALTH LINK
5	0062731	OTHER	AR	UMWA H&R FUNDS
6	2124296	OTHER	AR	UNITED HEALTHCARE
7	13692000000	OTHER	AR	QUALCHOICE
8	51967	OTHER	AR	BLUECROSSBLUESHIELD ARK
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	XX12984	OTHER	AR	HEALTH PLUS OF MICHIGAN

General Provider Information

NPI Number	:	1245200971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM GRAVES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 668
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-0668
Country	:	US
Telephone Number	:	479-754-8384
Fax Number	:	479-754-7141

Provider Business Practice Location Address
First Line	:	601 W MCKENNON ST
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-3523
Country	:	US
Telephone Number	:	479-754-8384
Fax Number	:	479-754-7141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/09/2007

Similar Medicare Providers

1447253810 — CLARKSVILLE MEDICAL GROUP, P.A.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

1083684740 — SUSAN GATELEY A.P.N.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

1770553448 — DR. LINDSEY J PREWITT M.D.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

1487624896 — DR. JOHN C DUNHAM M.D.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

1174593446 — DR. MARY JANELL BURCH M.D.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

1164482162 — JAMES BRIAN COTNER MD
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

Directions to “ DR. KIM GRAVES M.D.” Practice Location

Language	Start Address	Practice Location

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