Provider Demographics
NPI:1811999055
Name:GRANVILLE HEALTH SYSTEM
Entity type:Organization
Organization Name:GRANVILLE HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-690-3237
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0986
Mailing Address - Country:US
Mailing Address - Phone:919-693-6541
Mailing Address - Fax:919-693-7396
Practice Address - Street 1:110 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2756
Practice Address - Country:US
Practice Address - Phone:919-693-6541
Practice Address - Fax:919-693-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344646CMedicaid
NC014WAOtherBCBS
NC022FTOtherBCBS
NC344646AMedicaid
NC014WAOtherBCBS
NC344646CMedicaid
NC022FTOtherBCBS