Provider Demographics
NPI:1104847383
Name:GROVER CLINIC PC
Entity Type:Organization
Organization Name:GROVER CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-541-0925
Mailing Address - Street 1:10320 FELD FARM LN STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8484
Mailing Address - Country:US
Mailing Address - Phone:704-541-0925
Mailing Address - Fax:704-541-0924
Practice Address - Street 1:10320 FELD FARM LN STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8484
Practice Address - Country:US
Practice Address - Phone:704-541-0925
Practice Address - Fax:704-541-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301465261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136CTOtherBLUE CROSS BLUE SHIELD
NC89136CTMedicaid
NC89136CTMedicaid
NC2336372Medicare PIN