Basic Information
| Provider Information | |||||||||
| NPI: | 1174844286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIMES | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | TRI-COUNTY HEALTH CARE | ||||||||
| Address2: | 415 JEFFERSON ST NORTH | ||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564821296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313510 | ||||||||
| FaxNumber: | 2186317507 | ||||||||
| Practice Location | |||||||||
| Address1: | TRI-COUNTY HEALTH CARE OTTERTAIL CLINIC | ||||||||
| Address2: | 232 MN HWY 78 NORTH | ||||||||
| City: | OTTERTAIL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183646262 | ||||||||
| FaxNumber: | 2183676266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2010 | ||||||||
| LastUpdateDate: | 05/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125-057637 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2013-00541 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 58569 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.