Basic Information
| Provider Information | |||||||||
| NPI: | 1972618056 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFF GLOVER MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JEFFREY H GLOVER MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746 | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396490746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 ASTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GLOVER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6016842481 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 10993 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5023171 | 01 | MS | AETNA | OTHER | 00016354 | 05 | MS | MEDICAID | 1730117 | 01 | MS | UNITED HEALTHCARE | OTHER | 1387509 | 01 | LA | LOUISIANA MEDICAID | OTHER |