MEDICARE: AGRIPINA D GRINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	19716	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720039340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGRIPINA D GRINO MD

Provider Business Mailing Address
First Line	:	609 JAMES TRIMBLE BLVD
Second Line	:
City	:	PAINTSVILLE
State	:	KY
Zip	:	41240-1055
Country	:	US
Telephone Number	:	606-789-6844
Fax Number	:	606-789-4157

Provider Business Practice Location Address
First Line	:	609 JAMES TRIMBLE BLVD
Second Line	:
City	:	PAINTSVILLE
State	:	KY
Zip	:	41240-1055
Country	:	US
Telephone Number	:	606-789-6844
Fax Number	:	606-789-4157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/14/2010

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