Provider Demographics
NPI:1255398525
Name:GROGAN & HOWARD, P.S.C.
Entity type:Organization
Organization Name:GROGAN & HOWARD, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-9463
Mailing Address - Street 1:2603 KENTUCKY AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3815
Mailing Address - Country:US
Mailing Address - Phone:270-442-9463
Mailing Address - Fax:270-442-2241
Practice Address - Street 1:2603 KENTUCKY AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3815
Practice Address - Country:US
Practice Address - Phone:270-442-9463
Practice Address - Fax:270-442-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208255Medicare PIN
KY3157Medicare PIN
1255398525Medicare PIN