Provider Demographics
NPI:1174844286
Name:GRIMES, JESSICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:TRI-COUNTY HEALTH CARE
Mailing Address - Street 2:415 JEFFERSON ST NORTH
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1296
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:218-631-7507
Practice Address - Street 1:TRI-COUNTY HEALTH CARE OTTERTAIL CLINIC
Practice Address - Street 2:232 MN HWY 78 NORTH
Practice Address - City:OTTERTAIL
Practice Address - State:MN
Practice Address - Zip Code:56571
Practice Address - Country:US
Practice Address - Phone:218-364-6262
Practice Address - Fax:218-367-6266
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2018-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125-057637207Q00000X
NC2013-00541207Q00000X
MN58569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine