1306883673 NPI number — ALFRED H GRIMES PROFESSIONAL CORPORATION

Table of content: (NPI 1306883673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306883673 NPI number — ALFRED H GRIMES PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFRED H GRIMES PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PINNACLE PAIN MEDICINE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306883673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89533-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-747-5050
Provider Business Mailing Address Fax Number:
775-747-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89703-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-841-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMES
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
HOBSON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
775-841-7246

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100501290 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com