1720174535 NPI number — JENNIFER G. GROVES P.A.-C.

Table of content: JENNIFER G. GROVES P.A.-C. (NPI 1720174535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720174535 NPI number — JENNIFER G. GROVES P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVES
Provider First Name:
JENNIFER
Provider Middle Name:
G.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
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:
1720174535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-5420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-383-6469
Provider Business Mailing Address Fax Number:
703-385-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 HARRIS PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-877-3432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 363A00000X , with the licence number:  0110005261 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA901 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 99066589A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 10001825B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 10001825A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA901 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA15632 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ASC1019 . This is a "ASC MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4000501 . This is a "MEDICARE LAB GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 95005351 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37903705 . This is a "MEDICAID LAB GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00379405 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CB5773 . This is a "RR GROUP NO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 201162650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36000818 . This is a "ASC MEDICAID GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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