Grace Community Healthcare Ministry

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GRACE COMMUNITY HEALTHCARE MINISTRY

Practice address

312 N Pacific St
Mineola, TX 75773-1712

Phone

(903) 363-6361

Fax

(903) 569-0029

NPI assigned

Jul 25, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Susan Roach

Title

Administrator

Phone

(903) 363-6361

Specialties & licenses 1

Addresses

Other names 1

• Grace Community Healthcare Ministry Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Tony Phillips, PA

  • Physician Assistant
  • Mineola, TX
  • NPI 1003841560
  NPD (past)

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1619705134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 N PACIFIC ST",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731712",
            "telephone_number": "903-569-0020",
            "fax_number": "903-569-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N PACIFIC ST",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731712",
            "telephone_number": "903-363-6361",
            "fax_number": "903-569-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY HEALTHCARE MINISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-363-6361",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Community Healthcare Ministry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kerry Frazier, COTA
• Jamie Lee Galaz, RN
• Benjamin George
• Larry Clark Gooch, RPH
• Good Purpose Non-Emergency Medical Transportation
• Felicia Reenay Grimes
• Kyle L Gully, MD
• Andy Mark Hawari, O.D.
• Brianna Lynn Hazelwood, RN
• Health Care Center of Mineola, LTD

• All providers in Mineola, TX
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.