1942046412 NPI number — GRAY HEALTHCARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942046412 NPI number — GRAY HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAY HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942046412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 E SAN ANTONIO ST UNIT 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78124-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-200-0131
Provider Business Mailing Address Fax Number:
210-600-5943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 N LAVERNIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78124-2096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-200-0131
Provider Business Practice Location Address Fax Number:
210-600-5943
Provider Enumeration Date:
07/03/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRACTICE OWNER
Authorized Official Telephone Number:
830-200-0131

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)