Healthcare Provider Details

I. General information

NPI: 1356958276
Provider Name (Legal Business Name): PIVOTAL FOOT AND ANKLE SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W SAINT MAARTENS DR STE A
SAINT JOSEPH MO
64506-2989
US

IV. Provider business mailing address

1005 W SAINT MAARTENS DR STE A
SAINT JOSEPH MO
64506-2989
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-2338
  • Fax: 816-364-1003
Mailing address:
  • Phone: 816-364-2338
  • Fax: 816-364-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL SCOTT GRIMES
Title or Position: DPM
Credential: DPM
Phone: 816-364-2338