Grand Prairie Wellness Ctr

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GRAND PRAIRIE WELLNESS CTR

Practice address

1710 Small St
Grand Prairie, TX 75050-6041

Phone

(972) 266-9123

Fax

(972) 266-7383

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Chuck Poffenbarger

Title

President

Phone

(972) 266-9123

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glen Bruce Hake Jr., D.C.

  • Chiropractor
  • Grand Prairie, TX
  • NPI 1386911741
  NPD (past)
• Ingrid Cora Hinojosa, NP

  • Family Nurse Practitioner
  • Plano, TX
  • NPI 1851399240
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568475366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 SMALL ST",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750506041",
            "telephone_number": "972-266-9123",
            "fax_number": "972-266-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 SMALL ST",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750506041",
            "telephone_number": "972-266-9123",
            "fax_number": "972-266-7383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE WELLNESS CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POFFENBARGER",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-266-9123"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Prairie Medical Center LLC
• Grand Prairie Modern Dentistry, PC
• Grand Prairie Physician Group LLC
• Grand Prairie Professional Group, P. a.
• Grand Prairie Urgent Care PLLC
• Jessica Grant
• Shameka T Grant
• Tequila Grant
• Barbara Grantham, LPC
• Jenna Grantham

• Family Medicine Physician in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.