Provider Demographics
NPI:1598797342
Name:PAT GRIMES, INC.
Entity Type:Organization
Organization Name:PAT GRIMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRKLYN
Authorized Official - Middle Name:STRATTON
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-371-9181
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-0786
Mailing Address - Country:US
Mailing Address - Phone:540-371-9181
Mailing Address - Fax:540-899-6461
Practice Address - Street 1:2303 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-2115
Practice Address - Country:US
Practice Address - Phone:540-371-9181
Practice Address - Fax:540-899-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008999332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009134166Medicaid
0474837000OtherBLACK LUNG
VA027534OtherANTHEM
149352100OtherU.S. DEPT. OF LABOR
=========OtherPYRAMID LIFE
=========OtherHUMANA GOLD CHOICE
=========OtherUNITED HEALTHCARE
=========OtherUNITED AMERICAN
VA009134166Medicaid
=========OtherBANKERS LIFE & CASUALTY
149352100OtherU.S. DEPT. OF LABOR
=========OtherTRICARE
=========OtherAARP
=========OtherCIGNA HEALTHCARE
VA027534OtherANTHEM
=========OtherAETNA
VA0236990001Medicare NSC