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General NPI Number Information
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NPI Number | 1043339989
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Entity Type | Organization
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Legal Business Name | GRUNDY INTERNAL MEDICINE, PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 1532 SLATE CREEK ROAD STE 203
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City | GRUNDY
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State | VA
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Zip | 24614
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Country | US
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Telephone | 276-935-4858
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2855
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City | GRUNDY
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State | VA
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Zip | 24614-2855
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Country | US
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Telephone | 276-935-4858
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Fax | 276-935-5197
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SUSAN MCNUTT
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Credential |
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Telephone | 276-935-4858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101049088
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License Number State | VA
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