MEDICARE: CACHE VALLEY SURGICAL CONSULTANTS, PC

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	208600000X	Surgery Physician	5215595-1204	UT

General Provider Information

NPI Number	:	1982875878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACHE VALLEY SURGICAL CONSULTANTS, PC

Provider Business Mailing Address
First Line	:	2380 N 400 E STE E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1767
Country	:	US
Telephone Number	:	435-752-7123
Fax Number	:	435-755-9579

Provider Business Practice Location Address
First Line	:	2380 N 400 E STE E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1767
Country	:	US
Telephone Number	:	435-752-7123
Fax Number	:	435-755-9579

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. SCOTT W GROVER
Credential	:	D.O.
Telephone Number	:	435-752-7123

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	07/29/2024

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