| Gary Grimes Md A Professional Corporation | |
|
22801 Ventura Blvd Unit 115-c Woodland Hills CA 91364-1222 | |
| (661) 267-0777 | |
| Not Available |
| Full Name | Gary Grimes Md A Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 22801 Ventura Blvd Unit 115-c, Woodland Hills, California |
| Authorized Official Name and Position | Gary Grimes (CEO) |
| Authorized Official Contact | 6614998346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Grimes Md A Professional Corporation 22801 Ventura Blvd Unit 115-c Woodland Hills CA 91364-1222 Ph: () - | Gary Grimes Md A Professional Corporation 22801 Ventura Blvd Unit 115-c Woodland Hills CA 91364-1222 Ph: (661) 267-0777 |
| NPI Number | 1306685615 |
|---|---|
| Provider Enumeration Date | 05/24/2024 |
| Last Update Date | 05/24/2024 |
| Medicare PECOS PAC ID | 1052849577 |
|---|---|
| Medicare Enrollment ID | O20250113000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306685615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary A Grimes |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1922172089 PECOS PAC ID: 1557375656 Enrollment ID: I20060127000404 |
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