Theodore R Gover LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

THEODORE R GOVER LLC

Practice address

310 38TH St
Vienna, WV 26105-1722

Phone

(937) 570-0002

NPI assigned

Mar 16, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Theodore R Gover, PA-C

Title

Owner

Phone

(937) 570-0002

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1235714759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 38TH ST",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261051722",
            "telephone_number": "937-570-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 38TH ST",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261051722",
            "telephone_number": "937-570-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE R GOVER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "GOVER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-570-0002",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Sue Summers
• Harry Talbott Tebay, DDS
• Amanda Lynn Tennant
• Brittany Tennant
• Autumn Terrell
• Andrew R. Thomas, M.D.
• Ashley Thomas
• Christopher Thomas
• Dakota Rose Thompson
• Dan Thong Tran, FNP

• Health Maintenance Organization in Vienna, WV
• Providers in Vienna, WV by specialty
• Health Maintenance Organization in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.