MEDICARE: T L GRIMES CORPORATION

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831166198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T L GRIMES CORPORATION

Provider Business Mailing Address
First Line	:	2236 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2008
Country	:	US
Telephone Number	:	713-839-1420
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRAVIS GRIMES
Credential	:
Telephone Number	:	713-839-1420

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	12/14/2011

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