Provider Demographics
NPI:1053536698
Name:GRAPEVINE INTERNAL MEDICINE CENTRE
Entity type:Organization
Organization Name:GRAPEVINE INTERNAL MEDICINE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-481-8661
Mailing Address - Street 1:1604 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3544
Mailing Address - Country:US
Mailing Address - Phone:817-481-8661
Mailing Address - Fax:817-416-8801
Practice Address - Street 1:1604 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3544
Practice Address - Country:US
Practice Address - Phone:817-481-8661
Practice Address - Fax:817-416-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty