Basic Information
Provider Information
NPI: 1700208808
EntityType: 2
ReplacementNPI:  
OrganizationName: GRANT HOSPITALISTS SERVICES, LLC
LastName:  
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Mailing Information
Address1: 2622 DEER RUN DR
Address2:  
City: SOUTH WEBER
State: UT
PostalCode: 844059419
CountryCode: US
TelephoneNumber: 7024533799
FaxNumber: 7024535741
Practice Location
Address1: 400 S 15TH ST
Address2:  
City: WORLAND
State: WY
PostalCode: 824013531
CountryCode: US
TelephoneNumber: 7024533799
FaxNumber: 7024535741
Other Information
ProviderEnumerationDate: 01/09/2014
LastUpdateDate: 07/02/2014
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: GRANT
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: RAMIT
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8015641502
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X6367AWYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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