Grace Medical Association, Pa

LBN: Grace Medical Association, Pa
Grace Medical Association, Pa is an health care organization with primary practice located at 200 W. Southwest Pkwy , Lewisville TX 75067. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is the primary health care specialty. Grace Medical Association, Pa can be contacted via phone (972) 420-6777, or through Idemudia, Smart O via phone (972) 420-6777.

Contact Information

Primary practice address
200 W. Southwest Pkwy Lewisville TX 75067
Fax: (972) 420-0656
Website:
Authorized official contact:
Name: Idemudia, Smart O M.D., PHD.

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X J91000 Texas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X J91000 Texas

Profile Details

NPI number 1487695631
LBN Legal business name Grace Medical Association, Pa
DBA Doing business as
Authorized official Idemudia, Smart O M.D., PHD.
Entity Organization
Organization subpart 1 No
Enumeration date Jun 9th, 2006
Last updated Jun 2nd, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487695631 NPPES
Texas Other 0078DM BLUE CROSS / BLUE SHIELD
Texas MEDICAID 138993413 BLUE CROSS / BLUE SHIELD
Texas Other F46614 BLUE CROSS / BLUE SHIELD

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