Provider Demographics
NPI:1992848246
Name:KIMBERLY GRILL DO P L C
Entity Type:Organization
Organization Name:KIMBERLY GRILL DO P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-545-4700
Mailing Address - Street 1:1 MARYLAND FARMS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5425 PARK ST N
Practice Address - Street 2:SUITE 5 W
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-7062
Practice Address - Country:US
Practice Address - Phone:727-545-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56-25888726OtherTAX ID NUMBER