Provider Demographics
NPI:1295816312
Name:GROVES ER PHYSICIANS GROUP P A
Entity Type:Organization
Organization Name:GROVES ER PHYSICIANS GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:8328661900
Authorized Official - Phone:832-866-1900
Mailing Address - Street 1:14440 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-5300
Mailing Address - Country:US
Mailing Address - Phone:832-886-1900
Mailing Address - Fax:281-227-1139
Practice Address - Street 1:5500 39TH STREET
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-2905
Practice Address - Country:US
Practice Address - Phone:409-962-5733
Practice Address - Fax:409-963-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166546502Medicaid
TX166546501Medicaid
TX166546503Medicaid
TXB91350Medicare UPIN
TX00Y534Medicare PIN
TX166546501Medicaid
TX166546502Medicaid
TX00982WMedicare PIN
TX00Y346Medicare PIN