Organization
THEODORE R GOVER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THEODORE R GOVER PA-C (OWNER)
(937) 570-0002
Entity
Organization
Contact information
Practice address
310 38TH ST, VIENNA, WV 26105-1722
(937) 570-0002
Mailing address
310 38TH ST, VIENNA, WV 26105-1722
(937) 570-0002
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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