| John W Grace Md Pa | |
|
6226 W Corporate Oaks Dr Crystal River FL 34429-8723 | |
| (352) 795-2246 | |
| Not Available |
| Full Name | John W Grace Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6226 W Corporate Oaks Dr, Crystal River, Florida |
| Authorized Official Name and Position | John Willard Grace (PRESIDENT) |
| Authorized Official Contact | 3527952246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John W Grace Md Pa 6226 W Corporate Oaks Dr Crystal River FL 34429-8723 Ph: (352) 795-2246 | John W Grace Md Pa 6226 W Corporate Oaks Dr Crystal River FL 34429-8723 Ph: (352) 795-2246 |
| NPI Number | 1891982294 |
|---|---|
| Provider Enumeration Date | 09/29/2007 |
| Last Update Date | 09/30/2011 |
| Medicare PECOS PAC ID | 3779560065 |
|---|---|
| Medicare Enrollment ID | O20040706000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891982294 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME85580 (Florida) | Primary |
| Provider Name | John Willard Grace |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497725006 PECOS PAC ID: 6103803499 Enrollment ID: I20040709001014 |
| Provider Name | Karen Champagne Lister |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114069598 PECOS PAC ID: 8527139583 Enrollment ID: I20080618000502 |
| Provider Name | Joseph Alfred Bousquet |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003982174 PECOS PAC ID: 4688619679 Enrollment ID: I20180726000717 |
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