| Organization Name: | GRAND PRAIRIE MEDICAL GROUP, PLLC |
| NPI Number: | 1285047688 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CANDICE SMITH (BILLING SUPERVISOR) |
| Mailing Address: | 1012 E 22nd St Stuttgart |
| State: | AR US |
| Postal Code: | 721606825 |
| Phone Number: | 8706720911 |
| Fax Number: | 8706720914 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 11/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |