| Grace Internal Medicine LLC | |
|
114b Hospital Dr Simpsonville SC 29681-3226 | |
| (803) 757-5177 | |
| (803) 757-5178 |
| Full Name | Grace Internal Medicine LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 114b Hospital Dr, Simpsonville, South Carolina |
| Authorized Official Name and Position | Leon Buffaloe (PRESIDENT) |
| Authorized Official Contact | 8643608802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Internal Medicine LLC 114b Hospital Dr Simpsonville SC 29681-3226 Ph: (864) 757-5177 | Grace Internal Medicine LLC 114b Hospital Dr Simpsonville SC 29681-3226 Ph: (803) 757-5177 |
| NPI Number | 1962120071 |
|---|---|
| Provider Enumeration Date | 08/16/2022 |
| Last Update Date | 09/24/2024 |
| Certification Date | 09/24/2024 |
| Medicare PECOS PAC ID | 8224560420 |
|---|---|
| Medicare Enrollment ID | O20241014000096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962120071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
| Provider Name | Christina D Smith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043652118 PECOS PAC ID: 9739315854 Enrollment ID: I20131120001042 |
| Provider Name | Leon Buffaloe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366603391 PECOS PAC ID: 8820269277 Enrollment ID: I20150113000265 |
| Provider Name | Victoria Talley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447833280 PECOS PAC ID: 8921484296 Enrollment ID: I20240906002543 |
| Provider Name | Allison Elizabeth Patrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164263299 PECOS PAC ID: 7012441090 Enrollment ID: I20241113002729 |
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