1174956908 NPI number — JOHN GRIMES CRNP

Table of content: JOHN GRIMES CRNP (NPI 1174956908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174956908 NPI number — JOHN GRIMES CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMES
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1174956908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 OHARA DR
Provider Second Line Business Mailing Address:
APT/SUITE
Provider Business Mailing Address City Name:
ALBERTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35950-2597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-293-8141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7938 AL HWY 69
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GUNTERSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-571-8445
Provider Business Practice Location Address Fax Number:
256-571-8447
Provider Enumeration Date:
08/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  1-083810 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com