Healthcare Provider Details

I. General information

NPI: 1114676905
Provider Name (Legal Business Name): NATHAN ANTHONY GRIMALDI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MT CARMEL WAY
PITTSBURG KS
66762-7587
US

IV. Provider business mailing address

1 MT CARMEL WAY
PITTSBURG KS
66762-7587
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-6100
  • Fax:
Mailing address:
  • Phone: 620-231-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number94-12155
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: