MEDICARE: DR. RUSSELL SCOTT GRIMES D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	2006000709	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004030044	OTHER	KS	PTAN
2	1588635361	OTHER	KS	BLUE CROSS AND BLUE SHIELD OF KANSAS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588635361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL SCOTT GRIMES D.P.M.

Provider Business Mailing Address
First Line	:	1005 W SAINT MAARTENS DR STE A
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2989
Country	:	US
Telephone Number	:	816-364-2338
Fax Number	:	816-364-1003

Provider Business Practice Location Address
First Line	:	1005 W SAINT MAARTENS DR STE A
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2989
Country	:	US
Telephone Number	:	816-364-2338
Fax Number	:	816-364-1003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/11/2026

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Directions to “ DR. RUSSELL SCOTT GRIMES D.P.M.” Practice Location

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