Provider Demographics
NPI:1124054895
Name:GRANBURY INTERNAL MEDICINE ASSOCIATES, PC
Entity type:Organization
Organization Name:GRANBURY INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, GIMA,PC
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-573-8805
Mailing Address - Street 1:1318 PALUXY RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5655
Mailing Address - Country:US
Mailing Address - Phone:817-573-8805
Mailing Address - Fax:817-279-9515
Practice Address - Street 1:1318 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5655
Practice Address - Country:US
Practice Address - Phone:817-573-8805
Practice Address - Fax:817-279-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0825960-01Medicaid
TX00FX22Medicare ID - Type UnspecifiedGROUP NUMBER