Organization
EMERGENCY SPECIALISTS OF WELLINGTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GRIMES JR. (CFO)
(615) 551-6611
Entity
Organization
Contact information
Practice address
10101 W FOREST HILL BLVD, WELLINGTON, FL 33414-6103
(561) 798-8535
Mailing address
PO BOX 24085, FORT WORTH, TX 76124-1085
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274329900
—
FL
01
—
97008
BLUE CROSS BLUE SHIELD
FL
01
—
DE2986
MEDICARE RAILROAD
—
Enumeration date
05/12/2006
Last updated
01/27/2023
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