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Organization
GRAND MEDICAL CLINIC
Active
Organization
GRAND MEDICAL CLINIC
Active
Other names
Susan Baltz
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN A BALTZ FAMILY NURSE PRACTIT (FAMILY NURSE PRACTITIONER OWNER)
(806) 374-1919
Entity
Organization
Contact information
Practice address
1416 S HAYDEN ST, AMARILLO, TX 79102-1635
(806) 374-1919
(806) 379-9213
Mailing address
1416 S HAYDEN ST, AMARILLO, TX 79102-1635
(806) 374-1919
(806) 379-9213
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
K2883
TX
363LF0000X
Family Nurse Practitioner
Primary
251159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
092280502
NHIC
TX
05
—
092282501
—
TX
01
—
8P0790
BLUE CROSS
TX
Enumeration date
11/01/2006
Last updated
11/20/2009
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