Individual
EDWARD ALLAN GRIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
402 BOGLE ST, STE 3, SOMERSET, KY 42503-2870
(606) 451-9953
(606) 451-1533
Mailing address
402 BOGLE ST, STE 3, SOMERSET, KY 42503-2870
(606) 451-9953
(606) 451-1533
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
29702
KY
207R00000X
Internal Medicine Physician
Primary
29702
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000075035
ANTHEM
KY
01
—
04-906
UNITED HEALTHCARE
KY
01
—
1101698818
MEDICARE RAILROAD
KY
01
—
1181211
CHA
KY
01
—
37J8
ANTHEM
KY
01
—
5169150
CCN/AETNA
KY
01
—
611350780
FEDERAL TAX ID
KY
05
—
64297021
—
KY
Enumeration date
11/03/2005
Last updated
04/09/2015
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