Provider Demographics
NPI:1215659578
Name:GROSSMAN VIP INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:GROSSMAN VIP INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-695-8464
Mailing Address - Street 1:201 OAKBROOK LN STE 255
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7538
Mailing Address - Country:US
Mailing Address - Phone:843-851-2000
Mailing Address - Fax:843-851-2003
Practice Address - Street 1:201 OAKBROOK LN STE 255
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7538
Practice Address - Country:US
Practice Address - Phone:843-695-8464
Practice Address - Fax:843-695-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty