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Organization
GRACE CLINIC OF LUBBOCK
Active
Organization
GRACE CLINIC OF LUBBOCK
Active
Other names
Grace Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4515 MARSHA SHARP FWY, LUBBOCK, TX 79407-2520
(806) 744-7223
(806) 740-3325
Mailing address
PO BOX 676132, DALLAS, TX 75267-6132
(806) 744-7223
(806) 740-3325
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031NR
BCBS (GROUP #)
TX
01
—
0608DC
BCBS (OUTSIDE IMAGING)
TX
05
—
184774101
—
TX
01
—
CL5159
BCBS (OUTSIDE LABORATORY)
TX
Enumeration date
05/26/2006
Last updated
05/06/2025
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