Healthcare Provider Details

I. General information

NPI: 1407169733
Provider Name (Legal Business Name): CAMPBELLTON-GRACEVILLE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 COLLEGE DR STE B
GRACEVILLE FL
32440-1859
US

IV. Provider business mailing address

5429 COLLEGE DR STE B
GRACEVILLE FL
32440-1859
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-4431
  • Fax: 850-263-3312
Mailing address:
  • Phone: 850-263-4431
  • Fax: 850-263-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number StateZZ

VIII. Authorized Official

Name: MRS. JUDITH P AUSTIN
Title or Position: ASST ADMINISTRATOR
Credential:
Phone: 850-263-4431