| D&j Grace Team Llc | |
|
921 E Fm 1187 Ste A Crowley TX 76036-4364 | |
| (817) 945-1682 | |
| (817) 945-1685 |
| Full Name | D&j Grace Team Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 921 E Fm 1187 Ste A, Crowley, Texas |
| Authorized Official Name and Position | Ehab I Hanna (OWNER) |
| Authorized Official Contact | 8179451682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D&j Grace Team Llc 921 East Fm 1187 Suite A Crowley TX 76036 Ph: (817) 945-1682 | D&j Grace Team Llc 921 E Fm 1187 Ste A Crowley TX 76036-4364 Ph: (817) 945-1682 |
| NPI Number | 1093062937 |
|---|---|
| Provider Enumeration Date | 08/09/2012 |
| Last Update Date | 03/18/2021 |
| Medicare PECOS PAC ID | 0143477729 |
|---|---|
| Medicare Enrollment ID | O20120904000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093062937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Brent E Gooden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457389660 PECOS PAC ID: 1052224813 Enrollment ID: I20031107000283 |
| Provider Name | David Maldonado |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386624476 PECOS PAC ID: 6103858022 Enrollment ID: I20080912000125 |
| Provider Name | Samir R Atieh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306048715 PECOS PAC ID: 4082789813 Enrollment ID: I20100121000395 |
| Provider Name | Ehab I Hanna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063624302 PECOS PAC ID: 1456440825 Enrollment ID: I20100518000853 |
| Provider Name | Nagwa N Lamaie |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1417130485 PECOS PAC ID: 3274664412 Enrollment ID: I20100701000443 |
| Provider Name | Sasiwan Kamthong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457308967 PECOS PAC ID: 6608035068 Enrollment ID: I20120305000674 |
| Provider Name | Destiny Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063857654 PECOS PAC ID: 3173745734 Enrollment ID: I20141114000930 |
| Provider Name | Sheletha Bratton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649642497 PECOS PAC ID: 0941503908 Enrollment ID: I20160125002668 |
| Provider Name | Vidya Pai |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639402340 PECOS PAC ID: 3870730211 Enrollment ID: I20160525002425 |
| Provider Name | Uchenna N Iloma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265957757 PECOS PAC ID: 4486916285 Enrollment ID: I20180314001528 |
| Provider Name | Aida Fares Massaad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710459144 PECOS PAC ID: 1355772179 Enrollment ID: I20200512001514 |
| Provider Name | Rhonda Rusch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104417286 PECOS PAC ID: 2264848241 Enrollment ID: I20210317002175 |
| Provider Name | Medhat G Bedros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770571838 PECOS PAC ID: 3971549510 Enrollment ID: I20210323001080 |
| Provider Name | Allison S Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225609712 PECOS PAC ID: 8820494511 Enrollment ID: I20210903001020 |
| Provider Name | Christina M Bazan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851995682 PECOS PAC ID: 7113323973 Enrollment ID: I20210914002200 |
| Provider Name | Anitha A Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558013383 PECOS PAC ID: 8820482235 Enrollment ID: I20220301001950 |
| Provider Name | Carolyn Woahloe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154743839 PECOS PAC ID: 4789054305 Enrollment ID: I20230214000182 |
| Provider Name | Laura Carolyn Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326191701 PECOS PAC ID: 9133287790 Enrollment ID: I20230612001577 |
| Provider Name | Chi Nguyen Benson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508483082 PECOS PAC ID: 9335508027 Enrollment ID: I20230628002551 |
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