Provider Demographics
NPI:1275770166
Name:GRUBBS, SETH ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:ANDREW
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNTY HOSPITAL
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5349
Mailing Address - Country:US
Mailing Address - Phone:270-798-8130
Mailing Address - Fax:270-956-0180
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNTY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-798-8130
Practice Address - Fax:270-956-0180
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA1084360363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN