Provider Demographics
NPI:1942046412
Name:GRAY HEALTHCARE LLC
Entity type:Organization
Organization Name:GRAY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:210-864-7431
Mailing Address - Street 1:3235 HARVEST CRST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-1407
Mailing Address - Country:US
Mailing Address - Phone:210-864-7431
Mailing Address - Fax:210-600-5943
Practice Address - Street 1:3235 HARVEST CRST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:TX
Practice Address - Zip Code:78124-1407
Practice Address - Country:US
Practice Address - Phone:210-864-7431
Practice Address - Fax:210-600-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty