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General NPI Number Information
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NPI Number | 1255565313
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Entity Type | Organization
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Legal Business Name | GRANVILLE HEALTH INC
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 100 DURHAM STREET
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City | STOVALL
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State | NC
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Zip | 27582
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Country | US
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Telephone | 919-690-8880
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Fax | 919-690-8882
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Provider Business Mailing Address
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Address Line | PO BOX 986
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City | OXFORD
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State | NC
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Zip | 27565-0986
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Country | US
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Telephone | 919-690-8880
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Fax | 919-690-8882
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Authorized Official
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Title or Position | ADM DIRECTOR
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Name | GEORGEEN ERTISCHEK
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Credential |
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Telephone | 919-690-3280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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