Provider Demographics
NPI:1316124381
Name:GRAY GHOST INC
Entity type:Organization
Organization Name:GRAY GHOST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-890-3113
Mailing Address - Street 1:925 OLD SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9302
Mailing Address - Country:US
Mailing Address - Phone:937-890-3113
Mailing Address - Fax:937-890-5398
Practice Address - Street 1:925 OLD SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9302
Practice Address - Country:US
Practice Address - Phone:937-890-3113
Practice Address - Fax:937-890-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies