Active NPI
Granville Health Inc
- Family Medicine Physician
- Stovall, NC
National Provider Identifier
1255565313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- GRANVILLE HEALTH INC
- Practice address
- 100 Durham Street
Stovall, NC 27582 - Phone
- (919) 690-8880
- Fax
- (919) 690-8882
- NPI assigned
- May 5, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Georgeen Ertischek
- Title
- Adm Director
- Phone
- (919) 690-3280
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
100 Durham Street
Stovall, NC 27582
Mailing address
PO Box 986
Oxford, NC 27565-0986
Phone (919) 690-8880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5912213 | Medicaid | NC |
Other names 1
- Stovall Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090702000411 | NC | Part B Supplier - Clinic/Group Practice | 0840341822 |
Receives reassigned benefits from 11 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Oxford, NC |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Otolaryngology/Facial Plastic Surgery Physician
- Oxford, NC
- NPI 1043766686
O20090702000411
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241481600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1383091200000",
"number": "1255565313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 986",
"city": "OXFORD",
"state": "NC",
"postal_code": "275650986",
"telephone_number": "919-690-8880",
"fax_number": "919-690-8882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DURHAM STREET",
"city": "STOVALL",
"state": "NC",
"postal_code": "27582",
"telephone_number": "919-690-8880",
"fax_number": "919-690-8882"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRANVILLE HEALTH INC",
"organizational_subpart": "NO",
"enumeration_date": "2009-05-05",
"last_updated": "2013-10-30",
"status": "A",
"authorized_official_last_name": "ERTISCHEK",
"authorized_official_first_name": "GEORGEEN",
"authorized_official_title_or_position": "ADM DIRECTOR",
"authorized_official_telephone_number": "919-690-3280"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5912213",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Stovall Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Stovall, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.