Provider Demographics
NPI:1104000637
Name:ALLEN R GROEBS MD PC
Entity Type:Organization
Organization Name:ALLEN R GROEBS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISCHKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-747-1020
Mailing Address - Street 1:5323 SOUTH WOODROW STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-747-1020
Mailing Address - Fax:801-747-1023
Practice Address - Street 1:5323 SOUTH WOODROW STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-747-1020
Practice Address - Fax:801-747-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4916130-1205207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH21273Medicare UPIN
UT000057382Medicare PIN