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NPI Code Detail

MEDICARE: BRISTOL GRAY

MEDICARE: BRISTOL GRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1265385611
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRISTOL GRAY
Provider Business Mailing Address
First Line : 16 MOUNTAIN PARK DR
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-8992
Country : US
Telephone Number : 304-816-3687
Fax Number : 304-816-3737
Provider Business Practice Location Address
First Line : 16 MOUNTAIN PARK DR
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-8992
Country : US
Telephone Number : 304-816-3687
Fax Number : 304-816-3737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2026
Last Update Date : 02/17/2026

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Directions to “ BRISTOL GRAY ” Practice Location

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