NPIMap

Organization Active NPI

Superior Grace Enterprise LLC

  • Surgical Physician Assistant
  • Forney, TX
National Provider Identifier
1124552864
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
SA00597 Issued in TX
Legal business name
SUPERIOR GRACE ENTERPRISE LLC
Practice address
2005 Bishop Dr
Forney, TX 75126-4058
Phone
(214) 886-9766
NPI assigned
Apr 19, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sarah Moore, LSA
Title
Owner
Phone
(214) 886-9766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X SA00597 TX Primary

Addresses

Primary practice location

2005 Bishop Dr
Forney, TX 75126-4058

Mailing address

2005 Bishop Dr
Forney, TX 75126-4058
Phone (214) 886-9766

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1124552864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 BISHOP DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751264058",
            "telephone_number": "214-886-9766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 BISHOP DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751264058",
            "telephone_number": "214-886-9766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR GRACE ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-886-9766",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.