Provider Demographics
NPI:1689147498
Name:GRACE MEDICAL, PA
Entity Type:Organization
Organization Name:GRACE MEDICAL, PA
Other - Org Name:GRACE ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-989-4586
Mailing Address - Street 1:3319 WILD RIV
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2488
Mailing Address - Country:US
Mailing Address - Phone:281-989-4586
Mailing Address - Fax:
Practice Address - Street 1:10900 GULF FWY STE B102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-2581
Practice Address - Country:US
Practice Address - Phone:713-947-2232
Practice Address - Fax:713-947-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty