Provider Demographics
NPI:1598354607
Name:GRAYBEAL ORTHOPEDIC, LLC
Entity Type:Organization
Organization Name:GRAYBEAL ORTHOPEDIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-9884
Mailing Address - Street 1:107 E MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4631
Mailing Address - Country:US
Mailing Address - Phone:423-975-9884
Mailing Address - Fax:423-975-6678
Practice Address - Street 1:350 BLOUNTVILLE HWY STE 103
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1676
Practice Address - Country:US
Practice Address - Phone:423-612-1011
Practice Address - Fax:844-968-2180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYBEAL ORTHOPEDIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-13
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment