Individual
BRIAN GROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
303 N 1ST ST, STRASBURG, ND 58573-7214
(701) 336-7693
Mailing address
PO BOX 357, STRASBURG, ND 58573-0357
(701) 325-0354
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
GRO-81-7130
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56026
MEDICAID PROVIDER NUMBER
ND
Enumeration date
06/02/2014
Last updated
06/02/2014
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