| Grantmed | |
|
104 E Grove St El Dorado AR 71730 | |
| (870) 862-2285 | |
| (870) 862-2289 |
| Full Name | Grantmed |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 E Grove St, El Dorado, Arkansas |
| Authorized Official Name and Position | Jerry Henry Grant (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8708622285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grantmed 104 E Grove St El Dorado AR 71730-4607 Ph: (870) 862-2285 | Grantmed 104 E Grove St El Dorado AR 71730 Ph: (870) 862-2285 |
| NPI Number | 1366745705 |
|---|---|
| Provider Enumeration Date | 12/07/2010 |
| Last Update Date | 08/07/2019 |
| Medicare PECOS PAC ID | 2769671387 |
|---|---|
| Medicare Enrollment ID | O20110113000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366745705 | NPI | - | NPPES |
| 130237001 | Medicaid | AR | |
| 080128979 | Other | AR | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | E-0952 (Arkansas) | Primary |
| Provider Name | Gianna M Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427026939 PECOS PAC ID: 6406873769 Enrollment ID: I20051026001173 |
| Provider Name | Jerry H Grant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396714424 PECOS PAC ID: 1951328210 Enrollment ID: I20110113000626 |
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