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General NPI Number Information
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NPI Number | 1497002968
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Entity Type | Organization
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Legal Business Name | GRAYLING MEDICAL GROUP LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 240 HOSPITAL PLACE SUITE 103
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-260-5455
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Fax | 877-200-7122
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Provider Business Mailing Address
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Address Line | PO BOX 2509
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-260-5455
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Fax | 877-200-7122
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | NICOLE M ERB
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Credential | BSN,RN
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Telephone | 907-714-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 6826
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License Number State | AK
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