Provider Demographics
NPI:1831534726
Name:GRACE MONITORING
Entity type:Organization
Organization Name:GRACE MONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPHYSIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:214-516-2617
Mailing Address - Street 1:1431 GREENWAY DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:214-516-2617
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR
Practice Address - Street 2:SUITE 800
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2448
Practice Address - Country:US
Practice Address - Phone:214-516-2617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2033246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty