GRACE SOUTHERN MEDICAL CLINIC, PLLC (NPI# 1821486358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821486358 |
| Entity Type | Organization |
| Organization Name | GRACE SOUTHERN MEDICAL CLINIC, PLLC |
| Practice Address |
6300 Samuell Blvd Ste. 120 Dallas TX 75228-7137 |
| Practice Telephone | 2143811910 |
| Practice Fax Number | 2143812868 |
| Mailing Telephone | 2143811910 |
| Mailing Fax Number | 2143812868 |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |
| Authorized Official Name | SERGIO CALIXTO-MONTANEZ (MEMBER) |
| Authorized Official Telephone | 2143811910 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
P4031 | TX | Ambulatory Health Care Facilities |
| Street Address |
6300 SAMUELL BLVD STE. 120 |
| City | DALLAS |
| State | TX |
| Zip Code | 75228-7137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851535553 | Anthony Jamaine Allen | Chiropractor | 6300 Samuell Blvd, Ste. 145, Dallas, TX 75228-7137 | 2009-04-24 |
| 1881032720 | J Olivieri Professional Health Network LLC | Internal Medicine | 6300 Samuell Blvd, Ste 120, Dallas, TX 75228-7137 | 2013-06-13 |
| 1093064651 | Carolyne Chebet Limo | Family Medicine | 6300 Samuell Blvd, Suite 120, Dallas, TX 75228-7137 | 2012-08-29 |
| 1982981916 | Terrell Dialysis Center, LLC | Clinic/Center | 6300 Samuell Blvd, Suite 125, Dallas, TX 75228-7137 | 2011-11-04 |
| 1447562541 | Julio Olivieri | Internal Medicine | 6300 Samuell Blvd, Ste 120, Dallas, TX 75228-7137 | 2010-07-06 |
| 1316268162 | Sergio Calixto-montanez | Family Medicine | 6300 Samuell Blvd, Ste. 120, Dallas, TX 75228-7137 | 2010-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437625092 | Le Reve Rehab & Mc LLC | Skilled Nursing Facility | 3309 Dilido Road, Dallas, TX 75228 | 2018-10-22 |
| 1083905053 | R2j Investments LLC | Pharmacy | 6300 Samual Blvd, Ste #118, Dallas, TX 75228 | 2011-04-26 |
| 1376709493 | Rupen Suresh Amin | Family Medicine | 2360 Gus Thomasson Rd, Dallas, TX 75228 | 2008-07-29 |
| 1356512453 | Affirm Healthcare, LLC | Home Health | 10950 Woodmeadow Pkwy, #223, Dallas, TN 75228 | 2008-03-17 |
| 1629280110 | Shining Star Home Health Care Inc | Home Health | 8344 East R L Thronton Fwy, Ste # 203, Dallas, TX 75228 | 2007-05-04 |
| 1922123728 | Federico Maese | Family Medicine | 12601 E. Northwest Hwy, Dallas, TX 75228 | 2007-03-20 |
| 1578602223 | Rob F Smith | Social Worker | 8035 East R L Thornton Freeway, Suite #503, Dallas, TX 75228 | 2007-02-06 |
| 1710037023 | Candace Freeman Mcdaniel | Family Medicine | 8021 East R. L. Thornton Frwy, Suite A, Dallas, TX 75228 | 2007-01-11 |
| 1841376175 | Dana Ray Scott | Dentist | 2335 Gus Thomasson, Dallas, TX 75228 | 2006-10-30 |
| 1255425625 | Optimal Home Health Inc | Home Health | 8344 E R L Thornton Fwy Ste 214, Dallas, TX 75228 | 2006-10-03 |
| Find all providers in zip 75228 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659987022 | Specialists In Geriatric and Palliative Care Medicine Pllc | Clinic/Center | 8198 Walnut Hill Lane, Jackson Bldg, Suite 100, Dallas, TX 75231 | 2020-09-21 |
| 1285275560 | Heavenly Hands Family Medical Clinic, Pllc | Clinic/Center | 7602 Great Trinity Forest Way, Dallas, TX 75217-6650 | 2019-10-08 |
| 1740831098 | Careatc | Clinic/Center | 1500 Marilla St Rm 1cs, Dallas, TX 75201-6318 | 2019-09-26 |
| 1063077824 | Onepeak Medical Clinic, Inc | Clinic/Center | 1910 Greenville Ave, Dallas, TX 75206-7439 | 2019-05-07 |
| 1972068526 | Inkure U LLC | Clinic/Center | 8204 Elmbrook Dr Ste 202, Dallas, TX 75247-4067 | 2019-02-07 |
| 1548752850 | Susan Bacsik Do Pllc | Clinic/Center | 730 N Bishop Ave, Dallas, TX 75208-4338 | 2018-06-01 |
| 1255820239 | Fitzgerald Family Medicine | Clinic/Center | 289 E Ellendale Ave Ste 602, Dallas, OR 97338-1570 | 2018-05-06 |
| 1447759212 | Quadmed Medical Clinics of Texas, P.a. D/b/a Quadmed Medical Grou | Clinic/Center | 17655 Waterview Parkway, Dallas, TX 75252 | 2018-02-07 |
| 1700328325 | Daniel Health & Wellness, Pllc | Clinic/Center | 17762 Preston Rd Ste 114, Dallas, TX 75252-5730 | 2016-11-14 |
| 1407205222 | Jayshri Health Services | Clinic/Center | 6315 Lindsley Ave, Dallas, TX 75223-1312 | 2016-06-13 |
| Find all providers in DALLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.