Provider Demographics
NPI:1144645961
Name:GRIMES NEUROLOGY AND CONCUSSION CENTER, P.A.
Entity type:Organization
Organization Name:GRIMES NEUROLOGY AND CONCUSSION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-679-3270
Mailing Address - Street 1:800 DUNLAWTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4249
Mailing Address - Country:US
Mailing Address - Phone:386-679-3270
Mailing Address - Fax:
Practice Address - Street 1:800 DUNLAWTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4249
Practice Address - Country:US
Practice Address - Phone:386-679-3270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1069682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty