Provider Demographics
NPI:1336354836
Name:GRACE MEDICAL
Entity Type:Organization
Organization Name:GRACE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUKACS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-818-3301
Mailing Address - Street 1:6243 ANDREWS DR E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9313
Mailing Address - Country:US
Mailing Address - Phone:614-818-3301
Mailing Address - Fax:614-818-3302
Practice Address - Street 1:6243 ANDREWS DR E
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9313
Practice Address - Country:US
Practice Address - Phone:614-818-3301
Practice Address - Fax:614-818-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTIN
OH5000350001Medicare NSC