1013069541 NPI number — J KIRKLAND GRANT, M.D. PA

Table of content: (NPI 1013069541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013069541 NPI number — J KIRKLAND GRANT, M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J KIRKLAND GRANT, M.D. PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013069541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 S COLLINS RD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75182-4652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-686-8200
Provider Business Mailing Address Fax Number:
972-686-7711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 S COLLINS RD STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75182-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-686-8200
Provider Business Practice Location Address Fax Number:
972-686-7711
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRANT
Authorized Official First Name:
J KIRKLAND
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
972-686-8200

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  F4018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114499002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4272341 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10018543 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 084138901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3287 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81W310 . This is a "BC & BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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