=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912905613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH GROSHONG DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 10/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79-1019 HAUKAPILA ST
-----------------------------------------------------
City | KEALAKEKUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96750-7920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-322-9311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2295
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28802-2295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-398-5244
-----------------------------------------------------
Fax | 828-360-3080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | DOS638
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------