=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619926888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRUBBS & GRUBBS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3065 JUPITER PARK CIR SUITE 2
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-758-1945
-----------------------------------------------------
Fax | 561-745-5364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3065 JUPITER PARK CIR SUITE 1
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-758-1945
-----------------------------------------------------
Fax | 561-745-5364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT W GRUBBS
-----------------------------------------------------
Credential | LPO, CPO
-----------------------------------------------------
Telephone | 561-758-1945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | POR17
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------