Healthcare Provider Details

I. General information

NPI: 1326868613
Provider Name (Legal Business Name): GRANVILLE HEALTH SYSTEM ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LEWIS ST
OXFORD NC
27565-3523
US

IV. Provider business mailing address

PO BOX 986
OXFORD NC
27565-0986
US

V. Phone/Fax

Practice location:
  • Phone: 919-690-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE HOBGOOD
Title or Position: ACTING CEO
Credential:
Phone: 919-690-3445