Provider Demographics
NPI:1417361247
Name:GRAHAM PRIMARY HEALTHCARE
Entity Type:Organization
Organization Name:GRAHAM PRIMARY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-394-4387
Mailing Address - Street 1:200 S RHODES ST STE C1
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4212
Mailing Address - Country:US
Mailing Address - Phone:870-394-4387
Mailing Address - Fax:870-394-9751
Practice Address - Street 1:200 S RHODES ST STE C1
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4212
Practice Address - Country:US
Practice Address - Phone:870-394-4387
Practice Address - Fax:870-394-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty