Individual ProviderJohn GrimshawNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133(800) 566-5659(574) 529-1212PECOS EnrollmentBased on the most recent information from CMS, provider John Grimshaw is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1902314958Provider TypeIndividualFull NameGrimshaw, JohnTitleMr.CredentialFNP-CGenderMaleSole ProprietorNoEnumeration Date1/11/2018Last Updated1/11/2018Contact InformationPractice LocationPractice Address7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133Phone(800) 566-5659FaxUnlisted FaxMailing LocationMailing Address14394 Us Highway 6, Syracuse, IN 46567-9207Phone(574) 529-1212Fax(574) 528-5095Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicensePENDINGIndianaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense28202216AIndiana