Provider Demographics
NPI:1497253371
Name:JAYMES D. GRANATA, MD PLLC
Entity Type:Organization
Organization Name:JAYMES D. GRANATA, MD PLLC
Other - Org Name:BATTLE BORN BONE & JOINT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-944-0375
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4338
Mailing Address - Country:US
Mailing Address - Phone:702-765-0884
Mailing Address - Fax:702-765-0862
Practice Address - Street 1:7455 W WASHINGTON AVE STE 460
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4338
Practice Address - Country:US
Practice Address - Phone:702-765-0884
Practice Address - Fax:702-765-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15569OtherLICENSE