Healthcare Provider Details

I. General information

NPI: 1609121706
Provider Name (Legal Business Name): ERIC CHRISTOPHER GROVES C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7458
  • Fax:
Mailing address:
  • Phone: 304-389-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN68512-CRNA
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: