MEDICARE: GRACE PEDIATRICS AND FAMILY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	638038	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720194376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE PEDIATRICS AND FAMILY CLINIC

Provider Business Mailing Address
First Line	:	9207 COUNTRY CREEK DR
Second Line	:	SUITE 206
City	:	HOUSTON
State	:	TX
Zip	:	77036-7714
Country	:	US
Telephone Number	:	713-988-6835
Fax Number	:	713-988-5471

Provider Business Practice Location Address
First Line	:	9207 COUNTRY CREEK DR
Second Line	:	SUITE 206
City	:	HOUSTON
State	:	TX
Zip	:	77036-7714
Country	:	US
Telephone Number	:	713-988-6835
Fax Number	:	713-988-5471

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. ESTHER MGBEIKE
Credential	:	NP
Telephone Number	:	713-988-6835

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/29/2007

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Directions to “GRACE PEDIATRICS AND FAMILY CLINIC ” Practice Location

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