Provider Demographics
NPI:1316591829
Name:GROGAN FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:GROGAN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:765-827-1800
Mailing Address - Street 1:3024 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3073
Mailing Address - Country:US
Mailing Address - Phone:765-222-1400
Mailing Address - Fax:866-873-8524
Practice Address - Street 1:3024 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3073
Practice Address - Country:US
Practice Address - Phone:765-222-1400
Practice Address - Fax:866-873-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty