1003278474 NPI number — GRACE P TAMESIS MD PA

Table of content: (NPI 1003278474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003278474 NPI number — GRACE P TAMESIS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE P TAMESIS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003278474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16010 PARK VALLEY DR STE 300
Provider Second Line Business Mailing Address:
GRACE P. TAMESIS MD PA
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-3577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
737-203-9645
Provider Business Mailing Address Fax Number:
737-203-9646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16010 PARK VALLEY DR STE 300
Provider Second Line Business Practice Location Address:
GRACE P. TAMESIS MD PA
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-3577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
737-203-9645
Provider Business Practice Location Address Fax Number:
737-203-9646
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TAMESIS
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
303-601-5399

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  K1693 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K1693 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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