# GRAND PRAIRIE MEDICAL GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285047688
- **Authorized official:** CANDICE SMITH (BILLING SUPERVISOR)
- **Authorized official phone:** (903) 791-9355

## Contact information

- **Practice address:** 1012 E 22ND ST, STUTTGART, AR 72160-6825
- **Practice address phone:** (870) 672-0911
- **Practice address fax:** (870) 672-0914
- **Mailing address:** 1012 E 22ND ST, STUTTGART, AR 72160-6825
- **Mailing address phone:** (870) 672-0911
- **Mailing address fax:** (870) 672-0914

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/04/2014
- **Last updated:** 11/14/2014