Provider Demographics
NPI:1831151661
Name:GROGAN SMITH & MARTINI PL
Entity type:Organization
Organization Name:GROGAN SMITH & MARTINI PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:C RNA
Authorized Official - Phone:727-502-5969
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-0633
Mailing Address - Country:US
Mailing Address - Phone:727-450-3030
Mailing Address - Fax:727-450-3031
Practice Address - Street 1:148 13TH ST SW
Practice Address - Street 2:SUITE #200
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3127
Practice Address - Country:US
Practice Address - Phone:727-450-3030
Practice Address - Fax:727-450-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305305900Medicaid
FLDA9705OtherRAILROAD MEDICARE
FLG9029OtherBCBS
FLG9029OtherBCBS
FLG9029Medicare ID - Type Unspecified