Provider Demographics
NPI:1124063334
Name:GRIMMETT, GARFIELD M (MD)
Entity type:Individual
Prefix:
First Name:GARFIELD
Middle Name:M
Last Name:GRIMMETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8903207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDDA9011027841OtherPREFERRED ONE #
ND142013OtherUCARE #
ND2500521OtherMEDICA #
ND2500687OtherMEDICA #
ND030922200Medicaid
ND11600Medicaid
ND21867OtherNDBS #
ND2500568OtherMEDICA #
NDHP38673OtherHEALTHPARTNERS #
ND20845OtherNDBS #
ND58G26GROtherMNBS #
ND1344490OtherAMERICA'S PPO/ARAZ #
ND46G56GROtherMNBS #
NDND200218OtherLHS #
ND46G56GROtherMNBS #
ND060067662Medicare ID - Type UnspecifiedRR MEDICARE #
ND060065405Medicare ID - Type UnspecifiedRR MEDICARE #
ND11600Medicaid
NDND200218OtherLHS #