1033235742 NPI number — BILLY D. GRANT, D.C., PSC

Table of content: (NPI 1033235742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033235742 NPI number — BILLY D. GRANT, D.C., PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILLY D. GRANT, D.C., PSC
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:
6
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:
1033235742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1222 SKYLINE DRIVE
Provider Second Line Business Mailing Address:
SUITE A & B
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-885-2366
Provider Business Mailing Address Fax Number:
270-885-2356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1222 SKYLINE DR STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-885-2366
Provider Business Practice Location Address Fax Number:
270-885-2356
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRANT
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRACTIONER
Authorized Official Telephone Number:
270-885-2351

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000215455 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85900165 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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