Provider Demographics
NPI:1205022076
Name:AMY A GRISWOLD M D P A
Entity type:Organization
Organization Name:AMY A GRISWOLD M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-748-7246
Mailing Address - Street 1:1180 8TH AVE W
Mailing Address - Street 2:#311
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-3810
Mailing Address - Country:US
Mailing Address - Phone:941-748-7246
Mailing Address - Fax:941-748-7244
Practice Address - Street 1:842 62ND STREET CIR E STE 104
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6212
Practice Address - Country:US
Practice Address - Phone:941-748-7246
Practice Address - Fax:941-748-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67865261QP3300X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27433Medicare UPIN