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General NPI Number Information
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NPI Number | 1700973583
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Entity Type | Individual
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Provider Name | CALEB W GROVE P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 700 W CENTRAL AVE STE 105
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City | EL DORADO
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State | KS
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Zip | 67042-2187
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Country | US
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Telephone | 316-322-9813
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Fax | 316-322-9806
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Provider Business Mailing Address
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Address Line | 720 W CENTRAL AVE
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City | EL DORADO
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State | KS
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Zip | 67042-2112
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Country | US
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Telephone | 316-321-3300
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Fax | 316-321-2916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 15-01144
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | T00782
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License Number State | KS
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