Provider Demographics
NPI:1659045458
Name:VMC GRACE LLC
Entity Type:Organization
Organization Name:VMC GRACE LLC
Other - Org Name:GATEWAY HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKARIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:817-984-7540
Mailing Address - Street 1:921 E FM 1187 STE A100
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4363
Mailing Address - Country:US
Mailing Address - Phone:817-984-7540
Mailing Address - Fax:817-297-2010
Practice Address - Street 1:921 E FM 1187 STE A100
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4363
Practice Address - Country:US
Practice Address - Phone:817-984-7540
Practice Address - Fax:817-297-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty