Provider Demographics
NPI:1164946315
Name:ERIC M. GREBER, MD, LLC
Entity Type:Organization
Organization Name:ERIC M. GREBER, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEGENDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-492-1204
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0028
Mailing Address - Country:US
Mailing Address - Phone:985-492-1204
Mailing Address - Fax:985-492-1212
Practice Address - Street 1:726 N ACADIA RD STE 1000
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5009
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225320906OtherNPPES