Provider Demographics
NPI:1538357090
Name:HARLEY GRIM MD
Entity type:Organization
Organization Name:HARLEY GRIM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-931-3400
Mailing Address - Street 1:8250 WINTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5916
Mailing Address - Country:US
Mailing Address - Phone:513-931-3400
Mailing Address - Fax:513-728-2672
Practice Address - Street 1:8250 WINTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5916
Practice Address - Country:US
Practice Address - Phone:513-931-3400
Practice Address - Fax:513-728-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045973332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies