# THE GROVE PRIMARY CARE CLINIC LLC

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

## Provider details

- **NPI number:** 1790124097
- **Authorized official:** WILLIAM J WYSOR (PRESIDENT)
- **Authorized official phone:** (731) 695-3537

## Contact information

- **Practice address:** 702 S MAIN ST, MIDDLETON, TN 38052-3615
- **Practice address phone:** (731) 376-1311
- **Practice address fax:** (731) 376-1314
- **Mailing address:** 702 S MAIN ST, MIDDLETON, TN 38052-3615
- **Mailing address phone:** (731) 376-1311
- **Mailing address fax:** (731) 376-1314

## Taxonomy

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

## Other

- **Enumeration date:** 06/19/2013
- **Last updated:** 06/19/2013