The Grove Primary Care Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

THE GROVE PRIMARY CARE CLINIC LLC

Practice address

541 W Park PL
Suite C
Henderson, TN 38340-2027

Phone

(731) 983-0499

Fax

(731) 983-0573

NPI assigned

May 6, 2008

Organization subpart

No

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

Authorized official

Name

Jody Wysor

Title

Owner

Phone

(731) 983-0499

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1639345952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W PARK PL",
            "address_2": "SUITE C",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402027",
            "telephone_number": "731-983-0499",
            "fax_number": "731-983-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 W PARK PL",
            "address_2": "SUITE C",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402027",
            "telephone_number": "731-983-0499",
            "fax_number": "731-983-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GROVE PRIMARY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "WYSOR",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-983-0499"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Henderson, TN
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.