=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033003660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORYX MEN'S HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 N COURT AVE STE A
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49735-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-675-8963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 N COURT AVE STE A
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49735-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-675-8963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | AMY GRUBER
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 616-322-5479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------