1033255799 NPI number — ARTHUR GRAY INCORPORATED

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 1033255799 NPI number — ARTHUR GRAY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR GRAY INCORPORATED
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:
1033255799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 CALICO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557-4423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-726-1192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 LIVE OAK ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28516-1573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-838-8810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-726-1192

Provider Taxonomy Codes

  • Taxonomy code: 2251E1300X , with the licence number:  1028 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 079MN . This is a "INDIVIDUAL BLUE CROSS #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7211662 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7212089 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018PG . This is a "GROUP BLUE CROSS #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689698482 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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