Provider Demographics
NPI:1497131692
Name:GROVE & DIBETTA PLLC
Entity Type:Organization
Organization Name:GROVE & DIBETTA PLLC
Other - Org Name:IMMEDIATE MEDCARE AND FAMILY DOCTORS OF BRADENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-588-9572
Mailing Address - Street 1:6150 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9712
Mailing Address - Country:US
Mailing Address - Phone:941-822-8777
Mailing Address - Fax:
Practice Address - Street 1:6150 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9712
Practice Address - Country:US
Practice Address - Phone:941-822-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty