Provider Demographics
NPI:1356744858
Name:GRACE & MERCY HEALTH CLINIC, INC
Entity type:Organization
Organization Name:GRACE & MERCY HEALTH CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-396-7217
Mailing Address - Street 1:100 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-3008
Mailing Address - Country:US
Mailing Address - Phone:903-396-7217
Mailing Address - Fax:903-396-7258
Practice Address - Street 1:100 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-3008
Practice Address - Country:US
Practice Address - Phone:903-396-7217
Practice Address - Fax:903-396-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty