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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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