MEDICARE: CLOVER FAMILY CORP

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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies	00131	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30205	OTHER	NC	CHILD PHONE NUMBER

General Provider Information

NPI Number	:	1306825005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER FAMILY CORP

Provider Business Mailing Address
First Line	:	1040 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5046
Country	:	US
Telephone Number	:	336-222-8052
Fax Number	:	336-222-8091

Provider Business Practice Location Address
First Line	:	1040 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5046
Country	:	US
Telephone Number	:	336-222-8052
Fax Number	:	336-222-8091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON ALEXANDER
Credential	:
Telephone Number	:	919-812-4557

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	12/19/2019

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Directions to “CLOVER FAMILY CORP ” Practice Location

Language	Start Address	Practice Location

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