Provider Demographics
NPI:1952372500
Name:GRANVILLE HEALTH INC
Entity Type:Organization
Organization Name:GRANVILLE HEALTH INC
Other - Org Name:GRANVILLE SURGICAL ASSOCIATES
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 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:919-603-0368
Mailing Address - Fax:919-603-0842
Practice Address - Street 1:102 PROFESSIONAL PARK
Practice Address - Street 2:SUITE C
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2501
Practice Address - Country:US
Practice Address - Phone:919-603-0368
Practice Address - Fax:919-603-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347346AMedicare PIN