Healthcare Provider Details

I. General information

NPI: 1003150723
Provider Name (Legal Business Name): GRAYMONT EQUIPMENT DISTRIBUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 W HUBBARD ST
CHICAGO IL
60612-1614
US

IV. Provider business mailing address

2214 W HUBBARD ST
CHICAGO IL
60612-1614
US

V. Phone/Fax

Practice location:
  • Phone: 312-291-9305
  • Fax: 312-896-1436
Mailing address:
  • Phone: 312-291-9305
  • Fax: 312-896-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYCE BEASLEY
Title or Position: CEO
Credential:
Phone: 312-291-9305