Provider Demographics
NPI:1518156769
Name:MCCRAY MEDICAL SUPPLIES & SERVICES
Entity Type:Organization
Organization Name:MCCRAY MEDICAL SUPPLIES & SERVICES
Other - Org Name:MCCRAY MEDICAL SUPPLIES AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-605-6585
Mailing Address - Street 1:6 VILSONIA WAY
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9816
Mailing Address - Country:US
Mailing Address - Phone:501-605-6585
Mailing Address - Fax:
Practice Address - Street 1:6 VILSONIA WAY
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9816
Practice Address - Country:US
Practice Address - Phone:501-605-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health