Basic Information
| Provider Information | |||||||||
| NPI: | 1104847383 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROVER CLINIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10320 FELD FARM LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045410925 | ||||||||
| FaxNumber: | 7045410924 | ||||||||
| Practice Location | |||||||||
| Address1: | 10320 FELD FARM LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045410925 | ||||||||
| FaxNumber: | 7045410924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | GROVER | ||||||||
| AuthorizedOfficialFirstName: | ARUN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7045410925 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 200301465 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 136CT | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 89136CT | 05 | NC | MEDICAID |