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General NPI Number Information
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NPI Number | 1306143839
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Entity Type | Organization
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Legal Business Name | CAMPBELLTON-GRACEVILLE HOSPITAL
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 5429 COLLEGE DRIVE SUITE B
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City | GRACEVILLE
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State | FL
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Zip | 32440-1858
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Country | US
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Telephone | 850-263-0639
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Fax | 850-263-9726
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Provider Business Mailing Address
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Address Line | 5429 COLLEGE DRIVE SUITE B
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City | GRACEVILLE
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State | FL
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Zip | 32440-1858
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Country | US
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Telephone | 850-263-0639
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Fax | 850-263-9726
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JIMMY B RIGSBY
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Credential |
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Telephone | 850-263-4431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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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