Provider Demographics
NPI:1396383006
Name:GREY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:GREY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-310-8204
Mailing Address - Street 1:1081 W 59TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2307
Mailing Address - Country:US
Mailing Address - Phone:954-655-4689
Mailing Address - Fax:786-773-5941
Practice Address - Street 1:8825 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5409
Practice Address - Country:US
Practice Address - Phone:305-456-1463
Practice Address - Fax:786-464-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health