Provider Demographics
NPI:1477859460
Name:GRUBB MED
Entity Type:Organization
Organization Name:GRUBB MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JOYCE
Authorized Official - Middle Name:(NONE)
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-984-1542
Mailing Address - Street 1:10633 E APACHE TRL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3383
Mailing Address - Country:US
Mailing Address - Phone:480-984-1542
Mailing Address - Fax:480-986-6436
Practice Address - Street 1:10633 E APACHE TRL
Practice Address - Street 2:SUITE 106
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3383
Practice Address - Country:US
Practice Address - Phone:480-984-4912
Practice Address - Fax:480-986-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ143654Medicare PIN