1326217530 NPI number — GRAYCO MEDICAL

Table of content: (NPI 1326217530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326217530 NPI number — GRAYCO MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAYCO MEDICAL
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:
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:
1326217530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1343
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44212-8843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-570-2405
Provider Business Mailing Address Fax Number:
330-225-6535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3770 HEINLY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44212-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-570-2405
Provider Business Practice Location Address Fax Number:
330-225-6535
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-570-2405

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2858224 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com