NPIMap

Organization Active NPI

Campbellton-Graceville Hospital

Doing business as Graceville Medical Clinic

  • Family Medicine Physician
  • Graceville, FL
National Provider Identifier
1942348040
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME90551 Issued in FL
Legal business name
CAMPBELLTON-GRACEVILLE HOSPITAL
Doing business as
Graceville Medical Clinic
Practice address
5429 College Dr
Graceville, FL 32440-1857
Phone
(850) 263-4431
Fax
(850) 263-3312
NPI assigned
Feb 1, 2007
Last updated
Jul 14, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
CAMPBELLTON-GRACEVILLE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Dena R Cooper
Title
Controller
Phone
(850) 263-4431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME90551 FL Primary

Addresses

Primary practice location

5429 College Dr
Graceville, FL 32440-1857

Mailing address

5470 College Dr
Graceville, FL 32440-1304
Phone (850) 263-2459

Other identifiers 1

IdentifierTypeStateIssuer
060622701MedicaidFL

Other names 1

  • Graceville Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Atul Madan MD3 organizations share this tax ID, including this one
Part of
Atul Madan MD

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5470 College Dr
Graceville, FL 32440
Phone (850) 263-2459

Ownership & related parties

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1942348040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5470 COLLEGE DR",
            "city": "GRACEVILLE",
            "state": "FL",
            "postal_code": "324401304",
            "telephone_number": "850-263-2459",
            "fax_number": "850-263-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 COLLEGE DR",
            "city": "GRACEVILLE",
            "state": "FL",
            "postal_code": "324401857",
            "telephone_number": "850-263-4431",
            "fax_number": "850-263-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELLTON-GRACEVILLE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMPBELLTON-GRACEVILLE HOSPITAL",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DENA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "850-263-4431",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME90551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060622701",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Graceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.