ALICE PLACE MEDICAL CARE SERVICES NPI 1710654900

NPI Information

NPI: 1710654900
Provider Name: ALICE PLACE MEDICAL CARE SERVICES
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
2719 LA JOLLA BLVD
GRAND PRAIRIE, TX
ZIP 75054
Phone: (469) 756-7021
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ALICE PLACE MEDICAL CARE SERVICES is a family nurse practitioner in Grand Prairie, TX. ALICE PLACE MEDICAL CARE SERVICES NPI is 1710654900. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2719 LA JOLLA BLVD
GRAND PRAIRIE, TX
ZIP 75054-299
Phone: (469) 756-7021
Fax: (469) 502-3622

The provider's authorized official is Monnie E Adereti .
The authorized official title is Ceo and has the following contact phone number (469) 756-7021.

The enumeration date for this NPI number is 8/25/2021 and was last updated on 12/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes
2	251S00000X	Community/Behavioral Health				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	370763001	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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