# THEODORE R GOVER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235714759
- **Authorized official:** MR. THEODORE R GOVER PA-C (OWNER)
- **Authorized official phone:** (937) 570-0002

## Contact information

- **Practice address:** 310 38TH ST, VIENNA, WV 26105-1722
- **Practice address phone:** (937) 570-0002
- **Mailing address:** 310 38TH ST, VIENNA, WV 26105-1722
- **Mailing address phone:** (937) 570-0002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 03/16/2021
- **Last updated:** 03/16/2021