Provider Demographics
NPI:1477068849
Name:DANNIE W GLOVER
Entity Type:Organization
Organization Name:DANNIE W GLOVER
Other - Org Name:GLOVER PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-474-8005
Mailing Address - Street 1:1550 SPARTA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1315
Mailing Address - Country:US
Mailing Address - Phone:931-474-8005
Mailing Address - Fax:931-474-8007
Practice Address - Street 1:1550 SPARTA ST STE 7
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1315
Practice Address - Country:US
Practice Address - Phone:931-474-8005
Practice Address - Fax:931-474-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853878Medicaid