Healthcare Provider Details

I. General information

NPI: 1598741472
Provider Name (Legal Business Name): ROBERT W GRIMES JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8919 PARALLEL PKWY STE 555
KANSAS CITY KS
66112-3628
US

IV. Provider business mailing address

8919 PARALLEL PKWY STE 555
KANSAS CITY KS
66112-3628
US

V. Phone/Fax

Practice location:
  • Phone: 913-596-3940
  • Fax: 913-596-3730
Mailing address:
  • Phone: 913-596-3940
  • Fax: 913-596-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1500671
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number15-00671
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: