Healthcare Provider Details

I. General information

NPI: 1154074284
Provider Name (Legal Business Name): GRAYFISH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 SW SHADYVALE LN
TOPEKA KS
66619-1312
US

IV. Provider business mailing address

6703 SW SHADYVALE LN
TOPEKA KS
66619-1312
US

V. Phone/Fax

Practice location:
  • Phone: 785-431-8277
  • Fax: 785-266-3203
Mailing address:
  • Phone: 785-431-8277
  • Fax: 785-266-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAUN J FISHBACK
Title or Position: OWNER
Credential:
Phone: 785-431-8277