Provider Demographics
NPI:1629252986
Name:GRANVILLE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GRANVILLE HEALTH SYSTEM
Other - Org Name:GRANVILLE HOSPITALIST SPECIALTY GROUP
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0947
Mailing Address - Country:US
Mailing Address - Phone:909-690-8413
Mailing Address - Fax:919-603-1097
Practice Address - Street 1:1010 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2507
Practice Address - Country:US
Practice Address - Phone:919-690-8413
Practice Address - Fax:919-603-1097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANVILLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0098208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07705OtherBLUE CROSS/BLUE SHEILD NC