DR. TIMOTHY GUY GRUBE, D.O. - NPI NUMBER 1194720870

Summary

Provider Name: DR. TIMOTHY GUY GRUBE, D.O.

NPI Number: 1194720870

Clasification: Obstetrics & Gynecology (207V00000X)

Organization: COMPREHENSIVE WOMEN'S HEALTH SERVICES, P.C.

Address:
219 S BALLIET ST
FRACKVILLE, PA
ZIP 17931

Phone Number: (570) 874-1491



Detailed Information

DR. Timothy Guy Grube, D.O. is an OB/GYN physician in Frackville, PA with 19 years of experience. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. The assigned NPI number for this provider is 1194720870 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Graduation Year: 1995

The provider's business address is:

219 S BALLIET ST
FRACKVILLE, PA
ZIP 17931-105
Phone: (570) 874-1491
Fax: (570) 874-3404

The enumeration date for this NPI number is 6/17/2005 and was last updated on 1/3/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207V00000X Obstetrics & Gynecology OS009280L PA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 0018174270002 MEDICAID PA
2 038135RP0 MEDICARE ID-TYPE UNSPECIFIED PA
3 H16483 MEDICARE UPIN PA

NPI Record

No. Field Name Field Value
1 NPI 1194720870
2 Entity Type Code 1
3 Provider Last Name Legal Name GRUBE
4 Provider First Name TIMOTHY
5 Provider Middle Name GUY
6 Provider Name Prefix Text DR.
7 Provider Credential Text D.O.
8 Provider First Line Business Practice Location Address 219 S BALLIET ST
9 Provider Business Practice Location Address City Name FRACKVILLE
10 Provider Business Practice Location Address State Name PA
11 Provider Business Practice Location Address Postal Code 179312105
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 5708741491
14 Provider Business Practice Location Address Fax Number 5708743404
15 Provider Enumeration Date 6/17/2005
16 Last Update Date 1/3/2014
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 207V00000X
19 Provider License Number 1 OS009280L
20 Provider License Number State Code 1 PA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 0018174270002
23 Other Provider Identifier Type Code 1 05
24 Other Provider Identifier State 1 PA
25 Other Provider Identifier 2 038135RP0
26 Other Provider Identifier Type Code 2 04
27 Other Provider Identifier State 2 PA
28 Other Provider Identifier 3 H16483
29 Other Provider Identifier Type Code 3 02
30 Other Provider Identifier State 3 PA
31 Is Sole Proprietor N

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.