Provider Demographics
NPI:1154076438
Name:GRUMBLES GERIATRIC HOME VISITS PROGRAM, PLLC
Entity Type:Organization
Organization Name:GRUMBLES GERIATRIC HOME VISITS PROGRAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUMBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-682-3863
Mailing Address - Street 1:PO BOX 2283
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2283
Mailing Address - Country:US
Mailing Address - Phone:409-682-3863
Mailing Address - Fax:
Practice Address - Street 1:1908 POST OFFICE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2008
Practice Address - Country:US
Practice Address - Phone:409-682-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty