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GRACE SOUTHERN MEDICAL CLINIC, PLLC
NPI 1821486358
Clinic/Center - Primary Care in Dallas, TX

Active since January 07, 2015CLIA 45D2104254 · Waiver
6300 SAMUELL BLVD, STE. 120, DALLAS, TX 75228(214) 381-1910(214) 381-2868 Get Directions Write a Review

NPPES record last updated: January 7, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Grace Southern Medical Clinic, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRACE SOUTHERN MEDICAL CLINIC, PLLC (NPI 1821486358) is a healthcare organization registered as a primary care in Dallas, Texas and active in the NPI registry since January 2015. The organization holds a CLIA Waiver certificate valid through October 29, 2027 and lists Sergio Calixto-montanez, Member, as its authorized official.

NPPES Registry Identity

NPI1821486358
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameGRACE SOUTHERN MEDICAL CLINIC, PLLC
Location Address6300 SAMUELL BLVD, STE. 120Dallas, TX 75228-7137
Mailing Address6300 Samuell Blvd, Ste. 120Dallas, TX 75228-7137 · (214) 381-1910 · Fax (214) 381-2868
Phone(214) 381-1910
Fax(214) 381-2868
Organization SubpartNo
Authorized OfficialSergio Calixto-montanezMember · (214) 381-1910
Enumeration DateJanuary 7, 2015
✔ NPI 1821486358 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in TX · P4031
6300 SAMUELL BLVD, Dallas, TX 75228
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2104254

Grace Southern Medical, PLLC · Dallas, TX
Active · expires Oct 29, 2027
CLIA Number45D2104254
Laboratory TypePhysician Office
Certificate Effective DateOctober 30, 2025
Certificate Expiration DateOctober 29, 2027
Laboratory DirectorSergio Calixto-Montanez
Laboratory Phone(214) 381-1910
Laboratory LocationGrace Southern Medical, PLLC6300 Samuell Blvd Suite 120, Dallas, TX 75228
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAROLYNE CHEBET LIMO NP
Family Medicine
6300 SAMUELL BLVD, SUITE 120
DALLAS, TX 75228
Dallas County (214) 381-1910
DR. SERGIO CALIXTO-MONTANEZ M.D.
Family Medicine
6300 SAMUELL BLVD, STE. 120
DALLAS, TX 75228
Dallas County (214) 381-1910
JULIO OLIVIERI
Internal Medicine
6300 SAMUELL BLVD, STE 120
DALLAS, TX 75228
Dallas County (214) 381-1910
KAUSHIK V K VEDAM PHARMD
Pharmacist
6300 SAMUELL BLVD
DALLAS, TX 75228
Dallas County (972) 412-7373
ANGELLE ANDERSON MD
Family Medicine
6300 SAMUELL BLVD
DALLAS, TX 75228
Dallas County (214) 381-1910
DR. ANTHONY JAMAINE ALLEN D.C.
Chiropractor (Sports Physician)
6300 SAMUELL BLVD, STE. 145
DALLAS, TX 75228
Dallas County (214) 751-8960
J OLIVIERI PROFESSIONAL HEALTH NETWORK LLC
Internal Medicine
6300 SAMUELL BLVD, STE 120
DALLAS, TX 75228
Dallas County (214) 381-1910
TERRELL DIALYSIS CENTER, LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
6300 SAMUELL BLVD, SUITE 125
DALLAS, TX 75228
Dallas County (214) 388-8690

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grace Southern Medical Clinic, PLLC's NPI number?

The NPI number for Grace Southern Medical Clinic, PLLC is 1821486358. It was assigned to this organization in the NPPES registry on January 7, 2015.

Where is Grace Southern Medical Clinic, PLLC located?

Grace Southern Medical Clinic, PLLC is located at 6300 Samuell Blvd Ste. 120, Dallas, TX 75228. The listed phone number is (214) 381-1910.

What is Grace Southern Medical Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Grace Southern Medical Clinic, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2104254) is associated with this NPI, valid through October 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Grace Southern Medical Clinic, PLLC accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 3 other insurers list Grace Southern Medical Clinic, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Grace Southern Medical Clinic, PLLC was last updated on January 7, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.