| Grace Neurology Clinic, Pllc | |
|
505 N 6th St Longview TX 75601-6604 | |
| (903) 392-2307 | |
| (903) 392-2308 |
| Full Name | Grace Neurology Clinic, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 505 N 6th St, Longview, Texas |
| Authorized Official Name and Position | Rajani Ruth Caesar (PRESIDENT) |
| Authorized Official Contact | 4699516666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Neurology Clinic, Pllc 505 N 6th St Longview TX 75601-6604 Ph: (903) 392-2307 | Grace Neurology Clinic, Pllc 505 N 6th St Longview TX 75601-6604 Ph: (903) 392-2307 |
| NPI Number | 1134754658 |
|---|---|
| Provider Enumeration Date | 03/04/2020 |
| Last Update Date | 11/14/2023 |
| Certification Date | 11/14/2023 |
| Medicare PECOS PAC ID | 4880019298 |
|---|---|
| Medicare Enrollment ID | O20200803000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134754658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Rajani R Caesar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104020700 PECOS PAC ID: 8426101213 Enrollment ID: I20090727000316 |
Kimberly Clough Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1010 Tristan Ln, Longview, TX 75604 Phone: 903-918-6574 Fax: 903-704-0980 | |
Heather R. Mcconnell, M.a., Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 911 W Loop 281, Suite 423, Longview, TX 75604 Phone: 903-759-2402 Fax: 903-759-2570 | |
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Willem H. Fahrenbruck, Lpc, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3122 Nealy Way Ste 201, Longview, TX 75605 Phone: 903-452-8040 | |
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