Healthcare Provider Details

I. General information

NPI: 1598424699
Provider Name (Legal Business Name): JAMES M GRIMES ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 106A
ST AUGUSTINE FL
32080-3109
US

IV. Provider business mailing address

PO BOX 2230
ST AUGUSTINE FL
32085-2230
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-8365
  • Fax: 904-217-3224
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES M GRIMES
Title or Position: SOLE MEMBER
Credential: MD
Phone: 904-814-8365