Provider Demographics
NPI:1700241551
Name:KEN GRAY COMPANY INC.
Entity Type:Organization
Organization Name:KEN GRAY COMPANY INC.
Other - Org Name:BOLINGBROOK EXPRESS MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:630-914-5065
Mailing Address - Street 1:451 MALLVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2974
Mailing Address - Country:US
Mailing Address - Phone:630-914-5065
Mailing Address - Fax:
Practice Address - Street 1:451 MALLVIEW LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2974
Practice Address - Country:US
Practice Address - Phone:630-914-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEN GRAY COMPANY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-21
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173C00000X, 175F00000X, 246RP1900X, 367H00000X
IL1301356343900000X
IL5731DV347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty