Grace Gynecology & Wellness Corp Apmc

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

GRACE GYNECOLOGY & WELLNESS CORP APMC

Practice address

200 Beaullieu Dr Ste 3B
Lafayette, LA 70508-7230

Phone

(337) 522-7282

Fax

(337) 393-7057

NPI assigned

Oct 6, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Mika Marlaine King, M.D.NPI 1053311563

Title

Physician/President of Corp

Phone

(337) 654-4729

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

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

• Mika Marlaine King, MD

  • Obstetrics & Gynecology Physician
  • Lafayette, LA
  • NPI 1053311563
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1154083376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BEAULLIEU DR STE 3B",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087230",
            "telephone_number": "337-522-7282",
            "fax_number": "337-393-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BEAULLIEU DR STE 3B",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087230",
            "telephone_number": "337-522-7282",
            "fax_number": "337-393-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE GYNECOLOGY & WELLNESS CORP APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-06",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MIKA",
        "authorized_official_middle_name": "MARLAINE",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT OF CORP",
        "authorized_official_telephone_number": "337-654-4729",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashish Mavjibhai Goti, M.D.
• Shiho Goto, ATC
• Bryan Gottshall
• Anita J Gouri, D.D.S.
• Grace Counseling and Wellness LLC
• Grace Hospice and Palliative Care, LLC
• Grace Palliative Care LLC
• David Michael Grace, M.D.
• Graceful Balance Counseling and Consulting LLC
• Gracefully Grounded LLC

• Obstetrics & Gynecology Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Obstetrics & Gynecology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.