Provider Demographics
NPI:1154564987
Name:WILLIAM K. GRICE
Entity type:Organization
Organization Name:WILLIAM K. GRICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-948-1414
Mailing Address - Street 1:101 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4821
Mailing Address - Country:US
Mailing Address - Phone:252-948-1414
Mailing Address - Fax:252-948-0142
Practice Address - Street 1:101 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4821
Practice Address - Country:US
Practice Address - Phone:252-948-1414
Practice Address - Fax:252-948-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01505332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6233250001Medicare NSC