Provider Demographics
NPI:1568036721
Name:GRAYMONT EQUIPMENT DISTRIBUTION, LLC
Entity Type:Organization
Organization Name:GRAYMONT EQUIPMENT DISTRIBUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-291-9305
Mailing Address - Street 1:1621 W CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2501
Mailing Address - Country:US
Mailing Address - Phone:312-291-9305
Mailing Address - Fax:312-896-1436
Practice Address - Street 1:1621 W CARROLL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2501
Practice Address - Country:US
Practice Address - Phone:312-291-9305
Practice Address - Fax:312-896-1436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYMONT EQUIPMENT DISTRIBUTION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies