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Organization
CLEVELAND HEALTH VENTURES LLC
Active
Organization
CLEVELAND HEALTH VENTURES LLC
Active
Parent organization
CLEVELAND HEALTH VENTURES LLC
Other names
Clover Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLEVELAND HEALTH VENTURES LLC
Authorized official
MR. DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
3420 FILBERT HWY, CLOVER, SC 29710-5602
(803) 222-0600
(803) 222-6119
Mailing address
PO BOX 601544, CHARLOTTE, NC 28260-1544
(803) 222-0600
(803) 222-6119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4970
—
SC
Enumeration date
05/13/2008
Last updated
10/23/2008
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