Provider Demographics
NPI:1518285493
Name:GRANVILLE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GRANVILLE HEALTH SYSTEM
Other - Org Name:GRANVILLE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-690-3402
Mailing Address - Street 1:1040 COLLEGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-690-0471
Mailing Address - Fax:
Practice Address - Street 1:1040 COLLEGE STREET EXT
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-1642
Practice Address - Country:US
Practice Address - Phone:919-690-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1307341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC073FEOtherBCBS NC
NC3403828Medicaid
NC2783123Medicare PIN