Healthcare Provider Details

I. General information

NPI: 1104573609
Provider Name (Legal Business Name): GRAY URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TURNPIKE ACRES RD UNIT 2
GRAY ME
04039-9432
US

IV. Provider business mailing address

PO BOX 304
GRAY ME
04039-0304
US

V. Phone/Fax

Practice location:
  • Phone: 207-251-1177
  • Fax:
Mailing address:
  • Phone: 207-657-1165
  • Fax: 207-657-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANNA KITTREDGE
Title or Position: OWNER
Credential:
Phone: 207-657-1165