Provider Demographics
NPI:1366539223
Name:EADENS-GRIMBALL INTERNAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:EADENS-GRIMBALL INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:EADENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-451-9953
Mailing Address - Street 1:402 BOGLE ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2870
Mailing Address - Country:US
Mailing Address - Phone:606-451-9953
Mailing Address - Fax:606-451-1533
Practice Address - Street 1:402 BOGLE ST
Practice Address - Street 2:STE 3
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2870
Practice Address - Country:US
Practice Address - Phone:606-451-9953
Practice Address - Fax:606-451-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100049580Medicaid
KY7100049580Medicaid