GRACE HEALTHCARE SERVICES LLC NPI 1174669568

NPI Information

NPI: 1174669568
Provider Name: GRACE HEALTHCARE SERVICES, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
104 E MARKET ST
MC LEANSBORO, IL
ZIP 62859
Phone: (618) 643-3051
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GRACE HEALTHCARE SERVICES, LLC is a family nurse practitioner in Mc Leansboro, IL. GRACE HEALTHCARE SERVICES, LLC NPI is 1174669568. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

104 E MARKET ST
MC LEANSBORO, IL
ZIP 62859-317
Phone: (618) 643-3051
Fax: (618) 643-3164

The provider's authorized official is Rene L Trotter .
The authorized official title is Officer and has the following contact phone number (618) 643-3051.

The enumeration date for this NPI number is 1/30/2007 and was last updated on 4/20/2008.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family		ILLINOIS	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	DG2570	OTHER	ILLINOIS	RAILROAD MEDICARE#
2	=========	OTHER	ILLINOIS	EIN
3	788058	OTHER	ILLINOIS	HEALTHLINK #
4	P00425296	OTHER	ILLINOIS	RAILROAD MEDICARE #
5	Q24440	OTHER	ILLINOIS	UPIN #
6	318602171001	MEDICAID	ILLINOIS
7	K38114	MEDICARE PIN	ILLINOIS
8	03332007	OTHER	ILLINOIS	BCBS #
9	215155	MEDICARE PIN	ILLINOIS
10	1568446805	OTHER	ILLINOIS	PERSONAL NPI

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: 11/14/2023

NPI Synchronization or Removal

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