1295816312 NPI number — GROVES ER PHYSICIANS GROUP P A

Table of content: (NPI 1295816312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295816312 NPI number — GROVES ER PHYSICIANS GROUP P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROVES ER PHYSICIANS GROUP P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295816312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14440 JOHN F KENNEDY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77032-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-886-1900
Provider Business Mailing Address Fax Number:
281-227-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 39TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77619-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-962-5733
Provider Business Practice Location Address Fax Number:
409-963-5388
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOENIG
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
832-866-1900

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 166546502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166546501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166546503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com