# GRACE INTERNAL MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962120071
- **Authorized official:** LEON BUFFALOE (PRESIDENT)
- **Authorized official phone:** (864) 360-8802

## Contact information

- **Practice address:** 114B HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
- **Practice address phone:** (803) 757-5177
- **Practice address fax:** (803) 757-5178
- **Mailing address:** 114B HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
- **Mailing address phone:** (864) 757-5177
- **Mailing address fax:** (864) 757-5178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/16/2022
- **Last updated:** 09/24/2024