Provider Demographics
NPI:1871786673
Name:GRACE WOMENS CLINIC PA
Entity type:Organization
Organization Name:GRACE WOMENS CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES-JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-538-2014
Mailing Address - Street 1:2280 S CHURCH ST STE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5397
Mailing Address - Country:US
Mailing Address - Phone:336-538-2014
Mailing Address - Fax:336-538-2015
Practice Address - Street 1:2280 S CHURCH ST STE 201
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5397
Practice Address - Country:US
Practice Address - Phone:336-538-2014
Practice Address - Fax:336-538-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800935207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7911368Medicaid
022135915OtherD-U-N-S#
1053375535OtherRENDERING PROVIDER NPI
NC2349572OtherMEDICARE GROUP NUMBER
023X3OtherBCBS GROUP#
2260309AOtherPROVIDER PTAN
1871786673OtherGROUP NPI
NC2349572Medicare UPIN
1053375535OtherRENDERING PROVIDER NPI
NC2349572OtherMEDICARE GROUP NUMBER
NC7911368Medicaid