1851360010 NPI number — DR. JOEL T GRANT M.D.

Table of content: DR. JOEL T GRANT M.D. (NPI 1851360010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851360010 NPI number — DR. JOEL T GRANT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JOEL
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1851360010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 WARRIOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEPHENS CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22655-4044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-868-4100
Provider Business Mailing Address Fax Number:
540-868-0888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 WARRIOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEPHENS CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22655-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-868-4100
Provider Business Practice Location Address Fax Number:
540-868-0888
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101233394 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 75787 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0107195 . This is a "UNITED HEALTHCARE VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 861102088 . This is a "TAX ID AMERIHLTH, TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9588527 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010080029 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2124718 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0107692 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 137798 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 242915 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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