1467901132 NPI number — MEREDITH ROSE GRUBBS DPT

Table of content: MEREDITH ROSE GRUBBS DPT (NPI 1467901132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467901132 NPI number — MEREDITH ROSE GRUBBS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBBS
Provider First Name:
MEREDITH
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467901132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 WEST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-968-2001
Provider Business Mailing Address Fax Number:
479-964-2008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1661 AIRPORT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-767-2710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)