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General NPI Number Information
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NPI Number | 1326868613
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Entity Type | Organization
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Legal Business Name | GRANVILLE HEALTH SYSTEM ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 625 LEWIS ST
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City | OXFORD
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State | NC
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Zip | 27565-3523
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Country | US
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Telephone | 919-690-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 947
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City | OXFORD
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State | NC
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Zip | 27565-0947
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ADAM WEST MCCONNELL
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Credential |
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Telephone | 919-690-3405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy 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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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