=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639979081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE ANCHORED INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2025
-----------------------------------------------------
Last Update Date | 03/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19525 DOERRE RD
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-390-2533
-----------------------------------------------------
Fax | 888-875-4020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 LOUISIANA ST STE 3950
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-2859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-390-2533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. MELANIE LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-390-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------