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General NPI Number Information
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NPI Number | 1952729139
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Entity Type | Organization
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Legal Business Name | GROVES & MINER ENTERPRISES LLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 10700 S PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170
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Country | US
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Telephone | 405-691-9700
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Fax | 405-691-9702
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Provider Business Mailing Address
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Address Line | 10700 S PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-4207
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Country | US
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Telephone | 405-691-9700
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Fax | 405-691-9702
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Authorized Official
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Title or Position | OWNER/NP
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Name | PHILICIA M GROVES
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Credential | APRN
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Telephone | 405-350-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | OK
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