Provider Demographics
NPI:1982875878
Name:CACHE VALLEY SURGICAL CONSULTANTS, PC
Entity Type:Organization
Organization Name:CACHE VALLEY SURGICAL CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-752-7123
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2406
Mailing Address - Country:US
Mailing Address - Phone:345-752-7123
Mailing Address - Fax:435-755-9579
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:SUITE D
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:345-752-7123
Practice Address - Fax:435-755-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5215595-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty