Provider Demographics
NPI:1679202931
Name:GRASSROOTS CLINICAL SERVICES
Entity Type:Organization
Organization Name:GRASSROOTS CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:859-263-1382
Mailing Address - Street 1:2304 SIR BARTON WAY STE 195
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2741
Mailing Address - Country:US
Mailing Address - Phone:859-263-1382
Mailing Address - Fax:859-795-5275
Practice Address - Street 1:2304 SIR BARTON WAY STE 195
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2741
Practice Address - Country:US
Practice Address - Phone:859-263-1382
Practice Address - Fax:859-795-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service