Provider Demographics
NPI:1760274807
Name:GRACE HEALTH DIRECT PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:GRACE HEALTH DIRECT PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-587-9074
Mailing Address - Street 1:6100 COLLEYVILLE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8021
Mailing Address - Country:US
Mailing Address - Phone:817-587-9074
Mailing Address - Fax:817-803-8768
Practice Address - Street 1:6100 COLLEYVILLE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8021
Practice Address - Country:US
Practice Address - Phone:817-587-9074
Practice Address - Fax:817-803-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care