=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174636708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERN BONE AND JOINT SPECIALISTS A MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9330 STOCKDALE HWY SUITE 600
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-324-2491
-----------------------------------------------------
Fax | 661-324-1045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6001 TRUXTUN AVE STE 260B
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-0679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-324-2491
-----------------------------------------------------
Fax | 661-324-1045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES GRIMES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-324-2491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------