Provider Demographics
NPI:1083219638
Name:GRIGSBY, TOBIN HODGE JR
Entity Type:Individual
Prefix:
First Name:TOBIN
Middle Name:HODGE
Last Name:GRIGSBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 COLLEGE LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1207
Mailing Address - Country:US
Mailing Address - Phone:318-918-3268
Mailing Address - Fax:
Practice Address - Street 1:559 COLLEGE LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1207
Practice Address - Country:US
Practice Address - Phone:318-918-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)