Healthcare Provider Details

I. General information

NPI: 1770058182
Provider Name (Legal Business Name): AUSTIN WILLIAM GREWE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16687 SAINT CLAIR AVE STE 101
CALCUTTA OH
43920-9401
US

IV. Provider business mailing address

16687 SAINT CLAIR AVE STE 101
CALCUTTA OH
43920-9401
US

V. Phone/Fax

Practice location:
  • Phone: 330-967-1793
  • Fax: 234-338-9722
Mailing address:
  • Phone: 330-967-1793
  • Fax: 234-338-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060214
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008642RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: