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General NPI Number Information
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NPI Number | 1598424699
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Entity Type | Organization
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Legal Business Name | JAMES M GRIMES ORTHOPAEDICS LLC
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1301 PLANTATION ISLAND DR S STE 106A
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-3109
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Country | US
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Telephone | 904-814-8365
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Fax | 904-217-3224
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Provider Business Mailing Address
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Address Line | PO BOX 2230
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-2230
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Country | US
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Telephone | 904-824-4990
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Fax | 904-824-2226
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JAMES M GRIMES
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Credential | MD
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Telephone | 904-814-8365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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