Provider Demographics
NPI:1609687649
Name:GRIMES, JAMES KIRK
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KIRK
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 MEADOW GLEN LOOP
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9571
Mailing Address - Country:US
Mailing Address - Phone:541-205-3937
Mailing Address - Fax:
Practice Address - Street 1:15555 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:KENO
Practice Address - State:OR
Practice Address - Zip Code:97627-9719
Practice Address - Country:US
Practice Address - Phone:541-205-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR168986090343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)