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General NPI Number Information
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NPI Number | 1366539223
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Entity Type | Organization
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Legal Business Name | EADENS-GRIMBALL INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 402 BOGLE ST STE 3
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City | SOMERSET
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State | KY
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Zip | 42503-2870
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Country | US
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Telephone | 606-451-9953
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Fax | 606-451-1533
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Provider Business Mailing Address
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Address Line | 402 BOGLE ST STE 3
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City | SOMERSET
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State | KY
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Zip | 42503-2870
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Country | US
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Telephone | 606-451-9953
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Fax | 606-451-1533
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Authorized Official
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Title or Position | PHYSICIAN/OFFICE MANAGER
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Name | DR. DEBRA JO EADENS
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Credential | M.D.
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Telephone | 606-451-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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