Provider Demographics
NPI:1518919745
Name:GROVER, BRUCE S (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:S
Last Name:GROVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W STONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-6027
Mailing Address - Country:US
Mailing Address - Phone:423-247-5197
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:111 W STONE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-247-5197
Practice Address - Fax:423-247-5254
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21113207RP1001X
VA0101233245207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4604190OtherAETNA
TN1737428OtherUNITED HEALTHCARE
TN100024532OtherPHP TENN CARE
TN3061311Medicaid
TN62134825606OtherJOHN DEERE HEALTHCARE
TN0139819OtherBLUE CROSS BLUE SHIELD
VA030474OtherANTHEM
TN1000908Medicaid
KY64911787OtherKENTUCKY MEDICAID
VA006044182OtherVIRGINIA MEDICAID
TNZ101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
TN3287305Medicare PIN
GAP00195517Medicare PIN
TN62134825606OtherJOHN DEERE HEALTHCARE
GA290003834Medicare PIN
TN100024532OtherPHP TENN CARE
TN103G477120Medicare UPIN
TN3061311Medicare PIN
TN3061311Medicaid
TN103G477120Medicare PIN
TN1737428OtherUNITED HEALTHCARE
VA030474OtherANTHEM
E57819Medicare UPIN
VA017359P50Medicare PIN
TN3061313Medicare PIN