Provider Demographics
NPI:1629103098
Name:PAMELA DARLENE GROVE
Entity Type:Organization
Organization Name:PAMELA DARLENE GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-685-3030
Mailing Address - Street 1:10372 MARTINSVILLE HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-6889
Mailing Address - Country:US
Mailing Address - Phone:434-685-3030
Mailing Address - Fax:434-685-3075
Practice Address - Street 1:10372 MARTINSVILLE HIGHWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-685-3030
Practice Address - Fax:434-685-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002783261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496721Medicare Oscar/Certification