Provider Demographics
NPI:1326533175
Name:THE WOMEN'S CLINIC AT THE GROVE
Entity Type:Organization
Organization Name:THE WOMEN'S CLINIC AT THE GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VERUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-470-7969
Mailing Address - Street 1:5740 GETWELL RD
Mailing Address - Street 2:BUILDING 1, SUITE B
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672
Mailing Address - Country:US
Mailing Address - Phone:662-470-7969
Mailing Address - Fax:
Practice Address - Street 1:5740 GETWELL RD
Practice Address - Street 2:BUILDING 1, SUITE B
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672
Practice Address - Country:US
Practice Address - Phone:662-470-7969
Practice Address - Fax:662-470-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty