Provider Demographics
NPI:1164408571
Name:MED PLUS, INC
Entity Type:Organization
Organization Name:MED PLUS, INC
Other - Org Name:MED PLUS FLORENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUTZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-767-2702
Mailing Address - Street 1:2908 MALL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1534
Mailing Address - Country:US
Mailing Address - Phone:256-767-2702
Mailing Address - Fax:256-760-1870
Practice Address - Street 1:2908 MALL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1534
Practice Address - Country:US
Practice Address - Phone:256-767-2702
Practice Address - Fax:256-718-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE368Medicare ID - Type Unspecified