Grace Weekend Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

108529 Issued in MO

Legal business name

GRACE WEEKEND CLINIC, INC

Practice address

417 Park LN
Chillicothe, MO 64601-1550

Phone

(660) 646-3400

Fax

(660) 646-3410

NPI assigned

Oct 9, 2006

Last updated

Aug 9, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dea Denise Campbell, D.O.NPI 1275538324

Title

Owner/Operator

Phone

(660) 646-3400

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dea Denise Campbell, D.O.

  • Family Medicine Physician
  • Chillicothe, MO
  • NPI 1275538324
  Authorized official Same address or phone
• Gregory Lewis

  • Professional Counselor
  • Trenton, MO
  • NPI 1942771944
  NPD (past)
• Madison Lynn Vandyke, LMSW

  • Social Worker
  • Trenton, MO
  • NPI 1417834425
  NPD (past)
• Ayodele Adeleke Olusanya, MD

  • Internal Medicine Physician
  • Trenton, TN
  • NPI 1932155868
  NPD (past)

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186617600000",
    "number": "1225125461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 PARK LN",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "646011550",
            "telephone_number": "660-646-3400",
            "fax_number": "660-646-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 PARK LN",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "646011550",
            "telephone_number": "660-646-3400",
            "fax_number": "660-646-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE WEEKEND CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2007-08-09",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DEA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "660-646-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "108529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emilia Rose Galbraith, COTA/L
• Megan Marie Garber
• Jenna A Gibson, PHARM D
• Katherine Gibson
• Janice Jean Goddard, D.O.
• Grand River Health System Corporation (Hedrick Medical Center Home Health Agency)
• Bobbi J Gratton
• Gregory W Sensenich Inc
• Brenda Haley, RN, CDCES
• Hannibal Regional Healthcare System, Inc. (Complete Family Medicine)

• Family Medicine Physician in Chillicothe, MO
• Providers in Chillicothe, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; 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.