Organization
CLOVER FAMILY CORP
Active
Other names
CLOVER'S MASTECTOMY AND MEDICAL SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
JASON ALEXANDER (PRESIDENT)
(919) 812-4557
Entity
Organization
Contact information
Practice address
1040 S CHURCH ST, BURLINGTON, NC 27215-5046
(336) 222-8052
(336) 222-8091
Mailing address
1040 S CHURCH ST, BURLINGTON, NC 27215-5046
(336) 222-8052
(336) 222-8091
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00131
NC
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30205
CHILD PHONE NUMBER
NC
Enumeration date
01/11/2006
Last updated
12/19/2019
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