Provider Demographics
NPI:1942245626
Name:ANDREW D GRUBBS
Entity Type:Organization
Organization Name:ANDREW D GRUBBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-569-6780
Mailing Address - Street 1:PO BOX 632778
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2778
Mailing Address - Country:US
Mailing Address - Phone:513-891-7574
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:4015 EXECUTIVE PARK DR
Practice Address - Street 2:STE 406
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4017
Practice Address - Country:US
Practice Address - Phone:513-569-6747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE3554OtherRAILROAD MEDICARE
OH9357621Medicare PIN