Great Southwest Medical LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

K0566 Issued in TX

Legal business name

GREAT SOUTHWEST MEDICAL LLC

Practice address

643 S Great Southwest Pkwy
Suite 104
Grand Prairie, TX 75051-1056

Phone

(214) 363-5400

NPI assigned

Jul 18, 2013

Last updated

Jul 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rhonda R Guitreau

Title

Agent

Phone

(214) 382-1909

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1374105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1235571340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 S GREAT SOUTHWEST PKWY",
            "address_2": "SUITE 104",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 S GREAT SOUTHWEST PKWY",
            "address_2": "SUITE 104",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511056",
            "telephone_number": "214-363-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SOUTHWEST MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-18",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "GUITREAU",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "214-382-1909"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "TX",
            "license": "K0566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Grantham, LPC
• Jenna Grantham
• Great Southwest Family Dental
• Great Southwest Family Dental PA
• Great Southwest Family Dental Professional Association
• Greater Southwest Injury & Rehab Inc.
• Green Oaks Physical Therapy Limited Partnership (Green Oaks - Grand Praire)
• Green Oaks Physical Therapy LP
• Jerry Wayne Green, LPC
• Karina L Green, LPC

• Health Service Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Health Service Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; 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.