Organization
GRACE CLINIC IMAGING DEPARTMENT
Active
Parent organization
GRACE CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRACE CLINIC
Authorized official
DONALD WAYNE 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
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R30682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031NR
BCBS GROUP NO.
TX
01
—
0608DC
BCBS OUTSIDE IMAGING
TX
Enumeration date
07/02/2008
Last updated
05/06/2025
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