Provider Demographics
NPI:1134754658
Name:GRACE NEUROLOGY CLINIC, PLLC
Entity type:Organization
Organization Name:GRACE NEUROLOGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJANI
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:CAESAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-951-6666
Mailing Address - Street 1:505 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6604
Mailing Address - Country:US
Mailing Address - Phone:903-392-2307
Mailing Address - Fax:903-392-2308
Practice Address - Street 1:505 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6604
Practice Address - Country:US
Practice Address - Phone:903-392-2307
Practice Address - Fax:903-392-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty