Provider Demographics
NPI:1437122785
Name:GROVER F SCHLEIFER III MD PC
Entity Type:Organization
Organization Name:GROVER F SCHLEIFER III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-886-1240
Mailing Address - Street 1:1720 E. REELFOOT AVE.
Mailing Address - Street 2:STE 103
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6048
Mailing Address - Country:US
Mailing Address - Phone:731-886-1240
Mailing Address - Fax:731-886-1234
Practice Address - Street 1:1720 E. REELFOOT AVE.
Practice Address - Street 2:STE 103
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6048
Practice Address - Country:US
Practice Address - Phone:731-886-1240
Practice Address - Fax:731-886-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7070207Q00000X
TNRN0000036124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375882Medicaid
TNCK7717Medicare PIN
TN3375882Medicaid