Provider Demographics
NPI:1942489117
Name:JEFFREY W GROLIG M D INC
Entity Type:Organization
Organization Name:JEFFREY W GROLIG M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WENDALL
Authorized Official - Last Name:GROLIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-221-2520
Mailing Address - Street 1:5000 BECHELLI LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3553
Mailing Address - Country:US
Mailing Address - Phone:530-221-2520
Mailing Address - Fax:530-223-2899
Practice Address - Street 1:5000 BECHELLI LN
Practice Address - Street 2:SUITE 102
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3553
Practice Address - Country:US
Practice Address - Phone:530-221-2520
Practice Address - Fax:530-223-2899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY W GROLIG M D INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C414610Medicaid
CA171374100OtherDEPT OF LABOR PROVIDERS #
WA41461OtherDEPT OF LABOR PROVIDERS #
CAA37607Medicare UPIN
WA41461OtherDEPT OF LABOR PROVIDERS #