Provider Demographics
NPI:1720194376
Name:GRACE PEDIATRICS AND FAMILY CLINIC
Entity Type:Organization
Organization Name:GRACE PEDIATRICS AND FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MGBEIKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-988-6835
Mailing Address - Street 1:9207 COUNTRY CREEK DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7714
Mailing Address - Country:US
Mailing Address - Phone:713-988-6835
Mailing Address - Fax:713-988-5471
Practice Address - Street 1:9207 COUNTRY CREEK DR
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7714
Practice Address - Country:US
Practice Address - Phone:713-988-6835
Practice Address - Fax:713-988-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171880101Medicaid
TX171880101Medicaid