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NPI Code Detail

MEDICARE: GRANVILLE HEALTH INC

MEDICARE: GRANVILLE HEALTH INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1700858883
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANVILLE HEALTH INC
Provider Business Mailing Address
First Line : 1614 NC HIGHWAY 56
Second Line :
City : CREEDMOOR
State : NC
Zip : 27522-8297
Country : US
Telephone Number : 919-528-7171
Fax Number : 919-528-8797
Provider Business Practice Location Address
First Line : 1614 NC HIGHWAY 56
Second Line :
City : CREEDMOOR
State : NC
Zip : 27522-8297
Country : US
Telephone Number : 919-528-7171
Fax Number : 919-528-8797
Authorized Official
Title or Position : OFFICE MANAGER
Name : CRISTINA BLALOCK
Credential :
Telephone Number : 919-528-7171
Provider Enumeration Date : 02/03/2006
Last Update Date : 09/10/2009

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Directions to “GRANVILLE HEALTH INC ” Practice Location

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