Organization
PAT GRIMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIRKLYN STRATTON HUMPHREYS (PRESIDENT)
(540) 371-9181
Entity
Organization
Contact information
Practice address
2303 JEFFERSON DAVIS HWY, FREDERICKSBURG, VA 22401-2115
(540) 371-9181
(540) 899-6461
Mailing address
PO BOX 786, FREDERICKSBURG, VA 22404-0786
(540) 371-9181
(540) 899-6461
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0206008999
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009134166
—
VA
01
—
027534
ANTHEM
VA
01
—
0474837000
BLACK LUNG
—
01
—
149352100
U.S. DEPT. OF LABOR
—
Enumeration date
07/06/2006
Last updated
12/15/2011
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