Provider Demographics
NPI:1518266675
Name:GROSSO FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:GROSSO FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-879-8739
Mailing Address - Street 1:5927 STATE ROUTE 981
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2687
Mailing Address - Country:US
Mailing Address - Phone:724-879-8739
Mailing Address - Fax:724-879-4292
Practice Address - Street 1:5927 STATE ROUTE 981
Practice Address - Street 2:SUITE 8
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2687
Practice Address - Country:US
Practice Address - Phone:724-879-8739
Practice Address - Fax:724-879-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166654Medicare UPIN
PA211783Medicare PIN