MEDICARE: GRAY MEDICAL

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
1	332B00000X	Durable Medical Equipment & Medical Supplies		IL

General Provider Information

NPI Number	:	1720398399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAY MEDICAL

Provider Business Mailing Address
First Line	:	1621 W CARROLL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2501
Country	:	US
Telephone Number	:	312-291-9305
Fax Number	:	312-896-1436

Provider Business Practice Location Address
First Line	:	1621 W CARROLL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2501
Country	:	US
Telephone Number	:	312-291-9305
Fax Number	:	312-896-1436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATHAN GRAY
Credential	:
Telephone Number	:	312-291-9305

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	08/24/2020

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