Provider Demographics
NPI:1356958276
Name:PIVOTAL FOOT AND ANKLE SURGEONS LLC
Entity type:Organization
Organization Name:PIVOTAL FOOT AND ANKLE SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-364-2338
Mailing Address - Street 1:1005 W SAINT MAARTENS DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2989
Mailing Address - Country:US
Mailing Address - Phone:816-364-2338
Mailing Address - Fax:816-364-1003
Practice Address - Street 1:1005 W SAINT MAARTENS DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2989
Practice Address - Country:US
Practice Address - Phone:816-364-2338
Practice Address - Fax:816-364-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty