Healthcare Provider Details

I. General information

NPI: 1366151896
Provider Name (Legal Business Name): JOEL GROVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 RED HAWK RIDGE LN
O FALLON IL
62269-6938
US

IV. Provider business mailing address

1624 CARLYLE AVE # 392
BELLEVILLE IL
62221-4558
US

V. Phone/Fax

Practice location:
  • Phone: 314-517-4124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: