1013983733 NPI number — BARBARA LYNNE GROVE OD

Table of content: BARBARA LYNNE GROVE OD (NPI 1013983733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013983733 NPI number — BARBARA LYNNE GROVE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVE
Provider First Name:
BARBARA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GROVE
Provider Other First Name:
B
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013983733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 FALMOUTH RD
Provider Second Line Business Mailing Address:
UPPER LEVEL
Provider Business Mailing Address City Name:
MASHPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02649-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-477-1802
Provider Business Mailing Address Fax Number:
508-539-3713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 FALMOUTH RD
Provider Second Line Business Practice Location Address:
UPPER LEVEL
Provider Business Practice Location Address City Name:
MASHPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02649-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-477-1802
Provider Business Practice Location Address Fax Number:
508-539-3713
Provider Enumeration Date:
02/23/2006

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: 152W00000X , with the licence number:  2864 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 454369 . This is a "U S FAMILY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 454369 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S012088 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6895447 001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15619 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0352446 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15391 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 723151 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2200561 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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