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 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:423-282-1657
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21113207RC0200X, 207RP1001X
VA0101233245207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006044182OtherVIRGINIA MEDICAID
TN1000908Medicaid
TN0139819OtherBLUE CROSS BLUE SHIELD
VA030474OtherANTHEM
TN100024532OtherPHP TENN CARE
TNZ101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
TN1737428OtherUNITED HEALTHCARE
TN3061311Medicaid
TN4604190OtherAETNA
TN62134825606OtherJOHN DEERE HEALTHCARE
KY64911787OtherKENTUCKY MEDICAID
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