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NPI Code Detail

MEDICARE: COLLIN GRIMES PA-C

MEDICARE: COLLIN GRIMES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1184076119
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLIN GRIMES PA-C
Provider Business Mailing Address
First Line : 2901 S 74TH ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-5156
Country : US
Telephone Number : 479-709-6700
Fax Number :
Provider Business Practice Location Address
First Line : 3501 WE KNIGHT DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-6254
Country : US
Telephone Number : 479-409-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2016
Last Update Date : 10/03/2016

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Directions to “ COLLIN GRIMES PA-C” Practice Location

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