Provider Demographics
NPI:1194871970
Name:GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-693-2141
Mailing Address - Street 1:101 HUNT ST
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3414
Mailing Address - Country:US
Mailing Address - Phone:919-693-2141
Mailing Address - Fax:
Practice Address - Street 1:101 HUNT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3414
Practice Address - Country:US
Practice Address - Phone:919-693-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0721NOtherBCBS GRANVILLE
NC3404416Medicaid
NC3404391Medicaid
NC3404339Medicaid
0721POtherVANCE BCBS
=========OtherOTHER INSURANCE CARRIERS
=========OtherOTHER INSURANCE CARRIERS
2803065AMedicare ID - Type UnspecifiedVANCE MEDICARE