NPIMap

Organization Active NPI

Grant Clinic LLC

  • Addiction Medicine (Anesthesiology) Physician
  • Payson, AZ
National Provider Identifier
1528490968
Registry record updated Aug 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Anesthesiology) PhysicianTaxonomy code 207LA0401X
License
1609 Issued in AZ
Legal business name
GRANT CLINIC LLC
Practice address
708 S Coeur D Alene LN
Suite D
Payson, AZ 85541-5662
Phone
(925) 468-1337
Fax
(928) 468-1339
NPI assigned
Aug 8, 2013
Last updated
Aug 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2013

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

Authorized official

Name
Dr. Marc B Grant, D.O.NPI 1700857125
Title
President
Phone
(928) 468-1337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LA0401X 1609 AZ Primary

Addresses

Primary practice location

708 S Coeur D Alene LN
Suite D
Payson, AZ 85541-5662

Mailing address

708 S Coeur D Alene LN
Suite D
Payson, AZ 85541-5662
Phone (925) 468-1337

National Provider Directory

National Provider Directory

Locations

708 S Coeur D Alene Ln
Ste D
Payson, AZ 85541
Phone (925) 468-1337

Practitioners & affiliated clinicians

Practitioners 3

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": "1375920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375920000000",
    "number": "1528490968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S COEUR D ALENE LN",
            "address_2": "SUITE D",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415662",
            "telephone_number": "925-468-1337",
            "fax_number": "928-468-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 S COEUR D ALENE LN",
            "address_2": "SUITE D",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415662",
            "telephone_number": "925-468-1337",
            "fax_number": "928-468-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-08",
        "last_updated": "2013-08-08",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-468-1337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "AZ",
            "license": "1609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Payson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.