Provider Demographics
NPI:1992907463
Name:G E GROVES MD PA
Entity type:Organization
Organization Name:G E GROVES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-832-4900
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:STE 220
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:409-832-4900
Mailing Address - Fax:409-832-4940
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:STE 220
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-832-4900
Practice Address - Fax:409-832-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5172103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE54761Medicare UPIN
TX00F41RMedicare ID - Type Unspecified