Provider Demographics
NPI:1205886280
Name:CAMPBELLTON-GRACEVILLE HOSPITAL
Entity type:Organization
Organization Name:CAMPBELLTON-GRACEVILLE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-263-4431
Mailing Address - Street 1:5429 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-1857
Mailing Address - Country:US
Mailing Address - Phone:850-263-4431
Mailing Address - Fax:850-263-3312
Practice Address - Street 1:5429 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1857
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:2006-05-11
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4172282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010194000Medicaid
FL=========OtherFEDERAL TAX ID
FL101302Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER