Provider Demographics
NPI:1487184040
Name:JILL GROUNDS CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:JILL GROUNDS CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:GROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-582-1103
Mailing Address - Street 1:3345 PLAZA 10 DR. STE E
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2553
Mailing Address - Country:US
Mailing Address - Phone:409-838-2626
Mailing Address - Fax:409-838-1980
Practice Address - Street 1:3345 PLAZA 10 DR STE E
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2553
Practice Address - Country:US
Practice Address - Phone:409-838-2626
Practice Address - Fax:409-838-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty