Provider Demographics
NPI:1437338985
Name:JOHN W DEGROOTE PC
Entity Type:Organization
Organization Name:JOHN W DEGROOTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEGROOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-762-5982
Mailing Address - Street 1:4211 HOSPITAL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5320
Mailing Address - Country:US
Mailing Address - Phone:228-762-5982
Mailing Address - Fax:228-769-7698
Practice Address - Street 1:4211 HOSPITAL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5320
Practice Address - Country:US
Practice Address - Phone:228-762-5982
Practice Address - Fax:228-769-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00885861Medicaid
MS00885861Medicaid