Provider Demographics
NPI:1831296664
Name:GRAY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GRAY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-467-5600
Mailing Address - Street 1:1599 SOMERSET AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-0000
Mailing Address - Country:US
Mailing Address - Phone:814-467-5600
Mailing Address - Fax:814-467-5605
Practice Address - Street 1:1599 SOMERSET AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-0000
Practice Address - Country:US
Practice Address - Phone:814-467-5600
Practice Address - Fax:814-467-5605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAY MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017401280001Medicaid
PA1017401280001Medicaid