Individual
BRUCE S GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
(423) 282-1657
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101233245
VA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
21113
TN
207RP1001X
Pulmonary Disease Physician
0101233245
VA
207RP1001X
Pulmonary Disease Physician
Primary
21113
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006044182
VIRGINIA MEDICAID
VA
01
—
0139819
BLUE CROSS BLUE SHIELD
TN
01
—
030474
ANTHEM
VA
01
—
100024532
PHP TENN CARE
TN
05
—
1000908
—
TN
01
—
1737428
UNITED HEALTHCARE
TN
05
—
3061311
—
TN
01
—
4604190
AETNA
TN
01
—
62134825606
JOHN DEERE HEALTHCARE
TN
01
—
64911787
KENTUCKY MEDICAID
KY
01
—
Z101
UNITED HEALTHCARE OF THE RIVER VALLEY
TN
Enumeration date
05/16/2006
Last updated
01/10/2025
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