Provider Demographics
NPI:1811283245
Name:GRIEWISCH, ROY DENNIS
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:DENNIS
Last Name:GRIEWISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:CHARLES
Other - Last Name:GRIEWISCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9580 NIMS LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1302
Mailing Address - Country:US
Mailing Address - Phone:850-479-1766
Mailing Address - Fax:850-479-1768
Practice Address - Street 1:9580 NIMS LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1302
Practice Address - Country:US
Practice Address - Phone:850-479-1766
Practice Address - Fax:850-479-1768
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171WH0202X, 171WV0202X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No171WH0202XOther Service ProvidersContractorHome Modifications
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment