Healthcare Provider Details

I. General information

NPI: 1942245626
Provider Name (Legal Business Name): ANDREW D GRUBBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 406
CINCINNATI OH
45241-4017
US

IV. Provider business mailing address

PO BOX 632778
CINCINNATI OH
45263-2778
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6747
  • Fax:
Mailing address:
  • Phone: 513-891-7574
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANDREW GRUBBS
Title or Position: OWNER
Credential: MD
Phone: 513-569-6780