Provider Demographics
NPI:1407169733
Name:CAMPBELLTON-GRACEVILLE HOSPITAL
Entity Type:Organization
Organization Name:CAMPBELLTON-GRACEVILLE HOSPITAL
Other - Org Name:CAMPBELLTON-GRACEVILLE HOSPITAL PHYSICIANS' OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-263-4431
Mailing Address - Street 1:5429 COLLEGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-1859
Mailing Address - Country:US
Mailing Address - Phone:850-263-4431
Mailing Address - Fax:850-263-3312
Practice Address - Street 1:5429 COLLEGE DR STE B
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1859
Practice Address - Country:US
Practice Address - Phone:850-263-4431
Practice Address - Fax:850-263-3312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPBELLTON-GRACEVILLE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty