Provider Demographics
NPI:1376520676
Name:GRANE SUPPLY, INC.
Entity Type:Organization
Organization Name:GRANE SUPPLY, INC.
Other - Org Name:GRANE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:105 GAMMA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2950
Practice Address - Country:US
Practice Address - Phone:412-449-0680
Practice Address - Fax:412-968-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
PAPP414945L333600000X, 3336L0003X
DEA9-0001366333600000X
NJ28RO00098600333600000X
MDP06944333600000X
NY33899333600000X
OHNRP.022450950-03333600000X
WI1661-43333600000X
DCNRX0000927333600000X
NHNR1305333600000X
OK99-7543333600000X
VT36.0118428333600000X
WYNR-51151333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007611050008Medicaid
3968964OtherNCPDP GRANE SUPPLY
3968964OtherNCPDP GRANE SUPPLY
0887910001Medicare NSC
BG4231762OtherDEA GRANE SUPPLY