Provider Demographics
NPI:1952729139
Name:GROVES & MINER ENTERPRISES LLC
Entity type:Organization
Organization Name:GROVES & MINER ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:PHILICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-350-4300
Mailing Address - Street 1:10700 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4207
Mailing Address - Country:US
Mailing Address - Phone:405-691-9700
Mailing Address - Fax:405-691-9702
Practice Address - Street 1:10700 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-691-9700
Practice Address - Fax:405-691-9702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROVES ENTERPRISES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-03
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261Q00000X
OKR0062152261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200529800AMedicaid
360896OtherMEDICARE PTAN