Provider Demographics
NPI:1043202443
Name:GROCE, ANN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GROCE
Suffix:
Gender:F
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:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:STE 5B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050011789OtherRAILROAD MEDICARE
TN0100OtherJOHN DEER
TN3183511Medicaid
VA5747643Medicaid
100010283OtherPHP TENNCARE
NC5900464Medicaid
KY64775992Medicaid
3046933OtherBLUE SHIELD OF TN
063141OtherANTHEM BCBS
00013859OtherNHC CARE ADMINISTRATORS
100010283OtherPHP TENNCARE
3046933OtherBLUE SHIELD OF TN