Provider Demographics
NPI:1134465958
Name:GROVE MEDICAL INC
Entity Type:Organization
Organization Name:GROVE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SELIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-269-0283
Mailing Address - Street 1:1089 PARK WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-6124
Mailing Address - Country:US
Mailing Address - Phone:864-272-1541
Mailing Address - Fax:
Practice Address - Street 1:1089 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-6124
Practice Address - Country:US
Practice Address - Phone:864-272-1541
Practice Address - Fax:864-272-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC562402Medicaid