Healthcare Provider Details

I. General information

NPI: 1952729139
Provider Name (Legal Business Name): GROVES & MINER ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 S PENNSYLVANIA AVE
OKLAHOMA CITY OK
73170
US

IV. Provider business mailing address

10700 S PENNSYLVANIA AVE
OKLAHOMA CITY OK
73170-4207
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-9700
  • Fax: 405-691-9702
Mailing address:
  • Phone: 405-691-9700
  • Fax: 405-691-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: PHILICIA M GROVES
Title or Position: OWNER/NP
Credential: APRN
Phone: 405-350-4300