GRACE SOUTHERN MEDICAL CLINIC PLLC NPI 1821486358

NPI Information

NPI: 1821486358
Provider Name: GRACE SOUTHERN MEDICAL CLINIC, PLLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 45D2104254

Address:
6300 SAMUELL BLVD
STE. 120
DALLAS, TX
ZIP 75228
Phone: (214) 381-1910
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GRACE SOUTHERN MEDICAL CLINIC, PLLC is a primary care clinic center in Dallas, TX. GRACE SOUTHERN MEDICAL CLINIC, PLLC NPI is 1821486358. The provider is registered as an organization entity type.

The provider's business location address is:

6300 SAMUELL BLVD
STE. 120
DALLAS, TX
ZIP 75228-137
Phone: (214) 381-1910
Fax: (214) 381-2868

The provider's authorized official is Sergio Calixto-montanez .
The authorized official title is Member and has the following contact phone number (214) 381-1910.

The CLIA number assigned to this NPI record is 45D2104254 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/7/2015 and was last updated on 1/7/2015.

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	261QP2300X	Clinic/Center	Primary Care	P4031	TEXAS	Yes

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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