Provider Demographics
NPI:1568203487
Name:GRACE BREAST IMAGING & MEDICAL SPA PLLC
Entity type:Organization
Organization Name:GRACE BREAST IMAGING & MEDICAL SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPHIEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-505-3224
Mailing Address - Street 1:1250 NW 128TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7433
Mailing Address - Country:US
Mailing Address - Phone:515-505-3224
Mailing Address - Fax:
Practice Address - Street 1:1250 NW 128TH ST STE 130
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7433
Practice Address - Country:US
Practice Address - Phone:515-505-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography