Provider Demographics
NPI:1508398553
Name:MEDICINE WITH MERCY AND GRACE
Entity Type:Organization
Organization Name:MEDICINE WITH MERCY AND GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-295-9862
Mailing Address - Street 1:201 S WASHINGTON ST APT 401
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-2617
Mailing Address - Country:US
Mailing Address - Phone:980-295-9862
Mailing Address - Fax:704-406-9897
Practice Address - Street 1:210 W DALE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:980-295-9862
Practice Address - Fax:704-466-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000527261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126G9Medicaid
H16336Medicare UPIN
2280146Medicare PIN