# THE GROVE PRIMARY CARE CLINIC LLC

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

## Provider details

- **NPI number:** 1639345952
- **Authorized official:** JODY WYSOR (OWNER)
- **Authorized official phone:** (731) 983-0499

## Contact information

- **Practice address:** 541 W PARK PL, SUITE C, HENDERSON, TN 38340-2027
- **Practice address phone:** (731) 983-0499
- **Practice address fax:** (731) 983-0573
- **Mailing address:** 541 W PARK PL, SUITE C, HENDERSON, TN 38340-2027
- **Mailing address phone:** (731) 983-0499
- **Mailing address fax:** (731) 983-0573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/06/2008
- **Last updated:** 09/10/2019