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NPI Code Detail

MEDICARE: MR. ROBERT W GRIMES JR. PA-C

MEDICARE: MR. ROBERT W GRIMES JR. PA-C
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
1363A00000XPhysician Assistant1500671KS
2363AS0400XSurgical Physician Assistant15-00671KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115-00671OTHERKSSTATE PA LICENSE NUMBER

General Provider Information

NPI Number : 1598741472
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT W GRIMES JR. PA-C
Provider Business Mailing Address
First Line : 8919 PARALLEL PKWY STE 555
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-3628
Country : US
Telephone Number : 913-596-3940
Fax Number : 913-596-3730
Provider Business Practice Location Address
First Line : 8919 PARALLEL PKWY STE 555
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-3628
Country : US
Telephone Number : 913-596-3940
Fax Number : 913-596-3730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 12/03/2021

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