| Grace Physicians Services | |
|
1483 Old Cherokee Road Lexington SC 29072 | |
| (803) 766-7686 | |
| (803) 399-8038 |
| Full Name | Grace Physicians Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1483 Old Cherokee Road, Lexington, South Carolina |
| Authorized Official Name and Position | Kimberly Thomas-metts (OWNER) |
| Authorized Official Contact | 8037436411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Physicians Services 1483 Old Cherokee Road Lexington SC 29072 Ph: (803) 766-7686 | Grace Physicians Services 1483 Old Cherokee Road Lexington SC 29072 Ph: (803) 766-7686 |
| NPI Number | 1700484821 |
|---|---|
| Provider Enumeration Date | 10/12/2020 |
| Last Update Date | 12/15/2020 |
| Medicare PECOS PAC ID | 8628481090 |
|---|---|
| Medicare Enrollment ID | O20201231000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700484821 | NPI | - | NPPES |
| 253Z00000X | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jerri N Masanovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366922866 PECOS PAC ID: 6709138175 Enrollment ID: I20181012000730 |
| Provider Name | Michelle M Fields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760087845 PECOS PAC ID: 3072926492 Enrollment ID: I20210104001213 |
| Provider Name | Gerri A Kukucka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740888262 PECOS PAC ID: 1951714260 Enrollment ID: I20210106000318 |
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