Provider Demographics
NPI:1427356716
Name:GRAY SWAN SOFTWARE, LLC
Entity Type:Organization
Organization Name:GRAY SWAN SOFTWARE, LLC
Other - Org Name:AMBER CLINIC MANAGER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-746-9365
Mailing Address - Street 1:PO BOX 901999
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64190-1999
Mailing Address - Country:US
Mailing Address - Phone:816-746-9365
Mailing Address - Fax:432-225-2175
Practice Address - Street 1:5407 NW 83RD TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1027
Practice Address - Country:US
Practice Address - Phone:816-746-9365
Practice Address - Fax:432-225-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty