Provider Demographics
NPI:1598751216
Name:OSTEOPATHIC HERITAGE, P.A.
Entity Type:Organization
Organization Name:OSTEOPATHIC HERITAGE, P.A.
Other - Org Name:OSTEOPATHIC HERITAGE, CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
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:352-666-6950
Mailing Address - Street 1:118 SEVEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0235
Mailing Address - Country:US
Mailing Address - Phone:352-666-6950
Mailing Address - Fax:352-666-6438
Practice Address - Street 1:118 SEVEN HILLS DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0235
Practice Address - Country:US
Practice Address - Phone:352-666-6950
Practice Address - Fax:352-666-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
FLOS6098207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7182Medicare PIN