MEDICARE: PROMED PREFERRED AR PROFESSIONAL CORPORATION

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1659169621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED PREFERRED AR PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	329 S OYSTER BAY RD # 2059
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3531 CENTRAL AVE APT F
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6280
Country	:	US
Telephone Number	:	615-499-3165
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEV GRINMAN
Credential	:	MD
Telephone Number	:	615-499-3165

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “PROMED PREFERRED AR PROFESSIONAL CORPORATION ” Practice Location

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