Healthcare Provider Details

I. General information

NPI: 1841113990
Provider Name (Legal Business Name): RICHARD GRIZZLE EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 130TH AVE N
CLEARWATER KS
67026-8020
US

IV. Provider business mailing address

117 E 130TH AVE N
CLEARWATER KS
67026-8020
US

V. Phone/Fax

Practice location:
  • Phone: 620-440-1952
  • Fax:
Mailing address:
  • Phone: 620-440-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number66265
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: