Healthcare Provider Details

I. General information

NPI: 1093284549
Provider Name (Legal Business Name): TOWN SQUARE EMERGENCY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

PO BOX 24432
FORT WORTH TX
76124-1432
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-4208
  • Fax: 817-563-3699
Mailing address:
  • Phone: 817-451-4208
  • Fax: 817-563-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES GRIMES
Title or Position: CFO
Credential:
Phone: 615-551-6611