Dwight Grimm
Individual provider Active NPI Homemaker · Lake Waynoka, OH
NPI 1467069658 · NPPES record last updated Sep 30, 2020
Key facts
- NPI
- 1467069658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- Practice address
- 912 Waynoka Dr
Lake Waynoka, OH 45171-9760 - Phone
- (937) 446-4149
- NPI assigned
- Sep 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | Yes |
Addresses
Primary practice location
912 Waynoka Dr
Lake Waynoka, OH 45171-9760
Mailing address
912 Waynoka Dr
Lake Waynoka, OH 45171-9760
Phone (937) 446-4149
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2971048 | Medicaid | OH | |
| 0800557 | Medicaid | OH |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | g.vicki@yahoo.com | Health Information Exchange (HIE) |
Other providers in Lake Waynoka, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.