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Campbellton-Graceville Hospital

Organization Active NPI Family Medicine Physician · Graceville, FL

NPI 1154373744 · NPPES record last updated Aug 9, 2010

Key facts

NPI
1154373744
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
License
4172 (FL)
Legal business name
CAMPBELLTON-GRACEVILLE HOSPITAL
Practice address
5429 College Dr Ste B
Graceville, FL 32440-1859
Phone
(850) 263-4431
Fax
(850) 263-3312
NPI assigned
May 16, 2006
Organization subpart
Yes
Parent organization (as reported)
CAMPBELLTON-GRACEVILLE HOSPITAL

Authorized official

Name
Ms. Judy Austin
Title
Assistant Administrator
Phone
(850) 263-4431

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

National Provider Directory

Part of
Atul Madan MD

Locations

5429 College Dr
Graceville, FL 32440
Phone (850) 263-0639

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 4172 FL Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X 4172 FL
Endocrinology, Diabetes & Metabolism Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RE0101X 4172 FL
Geriatric Medicine (Internal Medicine) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RG0300X 4172 FL
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X 4172 FL

Addresses

Primary practice location

5429 College Dr Ste B
Graceville, FL 32440-1859

Mailing address

5429 College Dr
Graceville, FL 32440-1857
Phone (850) 263-4431

Other identifiers

IdentifierTypeStateIssuer
060622700MedicaidFL

Other providers in Graceville, FL

All providers in Graceville, FL · Family Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.