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GRACE HEALTH CLINIC NPI 1295290963


NPI Information

NPI: 1295290963
Provider Name: GRACE HEALTH CLINIC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 19D2158646

Address:
1415 CORPORATE SQUARE DR STE A
SLIDELL, LA
ZIP 70458
Phone: (985) 259-4854
Get Directions

GRACE HEALTH CLINIC is a family medicine in Slidell, LA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GRACE HEALTH CLINIC NPI is 1295290963. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1415 CORPORATE SQUARE DR STE A
SLIDELL, LA
ZIP 70458-151
Phone: (985) 259-4854
Fax: (855) 807-4750

The provider's authorized official is Bianca D Jackson .
The authorized official title is Clinic Administrator and has the following contact phone number (985) 259-4854.

The CLIA number assigned to this NPI record is 19D2158646 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2019 and was last updated on 6/17/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12427806MEDICAIDLOUISIANA
205427361MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.