NPIMap

Organization Active NPI

1661 W 2ND Corsicana Services, LLC

  • General Practice Dentistry
  • Corsicana, TX
National Provider Identifier
1083234744
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
1661 W 2ND CORSICANA SERVICES, LLC
Practice address
1661 W 2ND Ave
Corsicana, TX 75110-4107
Phone
(903) 872-1661
NPI assigned
Apr 23, 2020
Last updated
Apr 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter Grumbos, DDS
Title
Owner
Phone
(903) 872-1661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1661 W 2ND Ave
Corsicana, TX 75110-4107

Mailing address

1661 W 2ND Ave
Corsicana, TX 75110-4107
Phone (903) 872-1661

National Provider Directory

National Provider Directory
Tax ID family
1661 W 2ND Corsicana Professional PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1661 W 2nd Ave
Corsicana, TX 75110
Phone (903) 872-1661

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1083234744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 W 2ND AVE",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751104107",
            "telephone_number": "903-872-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 W 2ND AVE",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751104107",
            "telephone_number": "903-872-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1661 W 2ND CORSICANA SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-23",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "GRUMBOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-872-1661",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corsicana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.