Grace Healthcare Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GRACE HEALTHCARE LABORATORY, INC.

Practice address

1120 Broad Ave
Gulfport, MS 39501-2414

Phone

(228) 863-3331

Fax

(228) 863-3392

NPI assigned

Jul 13, 2005

Last updated

Dec 31, 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

Mr. David Wolf

Title

President

Phone

(228) 863-3331

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1275531261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012414",
            "telephone_number": "228-863-3331",
            "fax_number": "228-863-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012414",
            "telephone_number": "228-863-3331",
            "fax_number": "228-863-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HEALTHCARE LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-863-3331",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09752571",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Gottschalck, LCSW
• Johntre L Goudy, DMD
• Jeremy M Goulet, D.C.
• GPCH-GP, Inc. (Garden Park Medical Center)
• GPCH-GP, Inc. (Garden Park Medical Center)
• Grace Healthcare Medical Supply, Inc
• Grace Home Testing Inc
• Grace Medical Equipment Inc (Grace Healthcare)
• Graceful Pathways Inc
• Grady Consulting Services, LLC

• Clinical Medical Laboratory in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.