MEDICARE: DR. CHARLES ROUSE CLOVER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2012-00261	NC
2	208VP0014X	Interventional Pain Medicine Physician	2012-00261	NC
3	208VP0000X	Pain Medicine Physician	2012-00261	NC

General Provider Information

NPI Number	:	1518288828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ROUSE CLOVER M.D.

Provider Business Mailing Address
First Line	:	502 W KING ST STE LL20
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3362
Country	:	US
Telephone Number	:	704-862-4700
Fax Number	:	704-862-4749

Provider Business Practice Location Address
First Line	:	502 W KING ST # LL20
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3362
Country	:	US
Telephone Number	:	704-862-4700
Fax Number	:	704-862-4749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/02/2025

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