| Gracepoint | |
|
13601 Bruce B Downs Blvd. Suite 131 Tampa FL 33613-4610 | |
| (813) 239-8069 | |
| (813) 231-7324 |
| Full Name | Gracepoint |
|---|---|
| Speciality | Clinic/Center |
| Location | 13601 Bruce B Downs Blvd. Suite 131, Tampa, Florida |
| Authorized Official Name and Position | Roaya Tyson (CEO) |
| Authorized Official Contact | 8132398069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gracepoint 5707 N. 22nd Street Tampa FL 33610-4350 Ph: (813) 239-8069 | Gracepoint 13601 Bruce B Downs Blvd. Suite 131 Tampa FL 33613-4610 Ph: (813) 239-8069 |
| NPI Number | 1922777218 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 09/08/2022 |
| Medicare PECOS PAC ID | 2769469204 |
|---|---|
| Medicare Enrollment ID | O20220309000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922777218 | NPI | - | NPPES |
| 110069700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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