Organization Active NPI

Grace Pain & Wellness PLLC

  • Interventional Pain Medicine Physician
  • Plano, TX
National Provider Identifier
1508683202
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GRACE PAIN & WELLNESS PLLC
Practice address
6101 W Plano Pkwy Ste 200
Plano, TX 75093-8373
Phone
(404) 354-0153
NPI assigned
Sep 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Dr. Anthony Thaddeus Clavo, MD
Title
Medical Director
Phone
(404) 354-0153

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health & Wellness CoachGroup: 193200000X MULTI-SPECIALTY GROUP 171400000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

6101 W Plano Pkwy Ste 200
Plano, TX 75093-8373

Mailing address

4145 Belt Line Rd Ste 212-237
Addison, TX 75001-4324
Phone (404) 354-0153

National Provider Directory

National Provider Directory

Locations

4145 Belt Line Rd
Ste 212237
Addison, TX 75001

NPI Registry JSON

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

{
    "created_epoch": "1727136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1508683202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4145 BELT LINE RD STE 212-237",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750014324",
            "telephone_number": "404-354-0153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 W PLANO PKWY STE 200",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938373",
            "telephone_number": "404-354-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE PAIN & WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-24",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "CLAVO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "THADDEUS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-354-0153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.