MEDICARE: HOLLIS A GROOM CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	550830	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104822618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIS A GROOM CNM

Provider Business Mailing Address
First Line	:	2805 S MAYHILL RD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76208-5910
Country	:	US
Telephone Number	:	940-591-6700
Fax Number	:	940-320-1220

Provider Business Practice Location Address
First Line	:	4370 MEDICAL ARTS DR STE 300
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1724
Country	:	US
Telephone Number	:	940-591-6700
Fax Number	:	940-320-1220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	01/04/2022

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Directions to “ HOLLIS A GROOM CNM” Practice Location

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