Provider Demographics
NPI:1326217530
Name:GRAYCO MEDICAL
Entity Type:Organization
Organization Name:GRAYCO MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-570-2405
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-8843
Mailing Address - Country:US
Mailing Address - Phone:216-570-2405
Mailing Address - Fax:330-225-6535
Practice Address - Street 1:3770 HEINLY CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4441
Practice Address - Country:US
Practice Address - Phone:216-570-2405
Practice Address - Fax:330-225-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2858224Medicaid