Healthcare Provider Details

I. General information

NPI: 1174812838
Provider Name (Legal Business Name): STEVEN GROVE CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 YANCEYVILLE ST STE C
GREENSBORO NC
27405-6965
US

IV. Provider business mailing address

1403 YANCEYVILLE ST STE C
GREENSBORO NC
27405-6965
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-5155
  • Fax: 336-275-8530
Mailing address:
  • Phone: 336-272-5155
  • Fax: 336-275-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: