1427022045 NPI number — DR. MARY JO GROTE PHD

Table of content: (NPI 1528935004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427022045 NPI number — DR. MARY JO GROTE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROTE
Provider First Name:
MARY JO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1427022045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLLOCKSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28573-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-635-3906
Provider Business Mailing Address Fax Number:
252-224-0378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 WELLONS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-638-2515
Provider Business Practice Location Address Fax Number:
252-638-8538
Provider Enumeration Date:
02/13/2006

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: 231H00000X , with the licence number:  30001526 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5518-0001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007472511 . This is a "AETNA- PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265673 . This is a "MAMSI, OPTIMUM, MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9460144 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265673 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 272803 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54/1804291-001 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541804291 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3311009 . This is a "AETNA- HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541804291 . This is a "GREAT WEST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com