Provider Demographics
NPI:1033255799
Name:ARTHUR GRAY INCORPORATED
Entity Type:Organization
Organization Name:ARTHUR GRAY INCORPORATED
Other - Org Name:CRYSTAL COAST EMG-NCV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-726-1192
Mailing Address - Street 1:1700 CALICO DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4423
Mailing Address - Country:US
Mailing Address - Phone:252-726-1192
Mailing Address - Fax:
Practice Address - Street 1:1507 LIVE OAK ST
Practice Address - Street 2:SUITE D
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1573
Practice Address - Country:US
Practice Address - Phone:252-838-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10282251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079MNOtherINDIVIDUAL BLUE CROSS #
NC7211662Medicaid
NC7212089Medicaid
NC018PGOtherGROUP BLUE CROSS #
NC1689698482OtherINDIVIDUAL NPI #
NC7212089Medicaid