Provider Demographics
NPI:1730214990
Name:JACQUELYN GRIGGS
Entity type:Organization
Organization Name:JACQUELYN GRIGGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:713-505-1802
Mailing Address - Street 1:637 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3617
Mailing Address - Country:US
Mailing Address - Phone:713-505-1802
Mailing Address - Fax:888-473-1877
Practice Address - Street 1:637 W 20TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3617
Practice Address - Country:US
Practice Address - Phone:713-505-1802
Practice Address - Fax:888-473-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008338261QB0400X
TX601019367A00000X
367A00000X, 261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158371801Medicaid
TX179392901Medicaid
TX1793929-01OtherFACILITY MEDICAID #
TX158371801Medicaid