PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1588952758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588952758 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | GRANVILLE SPECIALTY CLINIC |
| Practice Address |
103 Professional Park Ste C Oxford NC 27565-2581 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9196903210 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-12-09 |
| Authorized Official Name | MR. MARK L CANTRELL (CHIEF PRIVACY & COMPLIANCE OFFICER) |
| Authorized Official Telephone | 9196685161 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Granville Specialty Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538616289 | Private Diagnostic Clinic, Pllc | Neurological Surgery | 1212 Cedarhurst Dr Ste 102, Raleigh, NC 27609-5588 | 2016-09-09 |
| 1083168181 | Private Diagnostic Clinic, Pllc | Internal Medicine | 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 | 2016-08-08 |
| 1124459292 | Private Diagnostic Clinic, Pllc | Occupational Therapist | Duke Clinic 1e, 40 Duke Medicine Circle, Durham, NC 27710-0001 | 2013-11-27 |
| 1609116664 | Private Diagnostic Clinic, Pllc | Dermatology | 82 Wheaton Ave, Youngsville, NC 27596-8691 | 2013-02-27 |
| 1487903423 | Private Diagnostic Clinic, Pllc | Pediatrics | 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 | 2012-09-06 |
| 1558639864 | Private Diagnostic Clinic, Pllc | Allergy & Immunology | 30 Duke Medicine Circle, Durham, NC 27710-3000 | 2011-12-01 |
| 1972826568 | Private Diagnostic Clinic, Pllc | Family Medicine | 800 Clayton Rd, Durham, NC 27703-2606 | 2010-03-10 |
| 1891021853 | Private Diagnostic Clinic, Pllc | Obstetrics & Gynecology | 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 | 2009-10-27 |
| 1447480413 | Private Diagnostic Clinic, Pllc | Orthopaedic Surgery | 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 | 2009-07-23 |
| 1841446762 | Private Diagnostic Clinic, Pllc | Otolaryngology | 783 Doctors Ct Ste C, Roxboro, NC 27573-4575 | 2008-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRIVATE DIAGNOSTIC CLINIC, PLLC | Duke University Medical Center, Durham, NC 27710-0001 |
| Street Address |
103 PROFESSIONAL PARK STE C |
| City | OXFORD |
| State | NC |
| Zip Code | 27565-2581 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760586150 | Rafael E Negron-medina | Orthopaedic Surgery | 103 Professional Park Ste C, Oxford, NC 27565-2581 | 2006-09-07 |
| 1215281936 | Instride Foot and Ankle Specialists, Pllc | Podiatrist | 103 Professional Park Ste C, Oxford, NC 27565-2581 | 2012-11-02 |
| 1457526907 | Granville Health System | Internal Medicine | 103 Professional Park Ste C, Oxford, NC 27565-2581 | 2008-04-25 |
| 1619189057 | Richard Joseph Pacca | Internal Medicine | 103 Professional Park Ste C, Oxford, NC 27565-2581 | 2007-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497378855 | Champion Heart and Vascular Center, Oxford Pllc | Internal Medicine | 1614 Williamsboro Street, Oxford, NC 27565 | 2020-05-20 |
| 1528536059 | Bridget Shouse Clark | Social Worker | 6271 Horner Siding Rd, Oxford, NC 27565 | 2018-11-02 |
| 1972038495 | Brittany Adams | Pharmacist | 215 Williamsboro Street, Oxford, NC 27565 | 2017-04-21 |
| 1487199568 | Duke University Affiliated Physicians, Inc. | Family Medicine | 1490 Williamsboro St., Oxford, NC 27565 | 2016-12-29 |
| 1801343819 | Four County Orthopedics Pa | Orthopaedic Surgery | 103 Professional Park Drive, Suite C, Oxford, NC 27565 | 2016-09-07 |
| 1548644842 | Drake Frazier and Mcneal, Dds, Pa | Dentist | 115 Williamsboro St., Oxford, NC 27565 | 2015-07-16 |
| 1982082251 | Colleen Moore | Pharmacist | 700 B Hillsboro St, Oxford, NC 27565 | 2015-05-07 |
| 1073753497 | Yashica Yvonne Ruffin | Family Medicine | 1015 Lewis Street, Oxford, NC 27565 | 2009-02-25 |
| 1205021631 | Helping Hands Alternative Inc | Home Health | 121 East Mcclanahan Street, Oxford, NC 27565 | 2007-09-10 |
| 1730380874 | Hushang Ghodrat, Dds, Pa | Dentist | 1419 College Street, Suite B, Oxford, NC 27565 | 2007-05-29 |
| Find all providers in zip 27565 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427406362 | Andrew Clark Whittington | Internal Medicine | 81 Ed Perry Blvd Ste 107, Oxford, MS 38655-3465 | 2016-06-01 |
| 1487918900 | Seger Stacy Morris | Internal Medicine | 100 Baptist Memorial Cir Ste 200, Oxford, MS 38655-4476 | 2012-06-28 |
| 1184985244 | Brett Thomas Person | Internal Medicine | 1000 University Ave, House Number 5, Oxford, MS 38655-3966 | 2012-06-06 |
| 1124209986 | Margaret Swain-gray, M.d. | Internal Medicine | 2222 Old Baltimore Pike, Oxford, PA 19363 | 2007-11-21 |
| 1831389832 | Natalie M Lindell | Internal Medicine | 6 Allen Parkway, Oxford, AL 36203 | 2007-07-26 |
| 1790908721 | Sollage Pain Solutions of Fl | Internal Medicine | 1922 Mount Zion Rd, Oxford, GA 30054-2624 | 2007-04-10 |
| 1689769895 | Millennium Health Clinic | Internal Medicine | 1713 Hamric Dr E, Oxford, AL 36203-2015 | 2006-10-04 |
| 1801902309 | Milton D Hobbs | Internal Medicine | 551 Azalea Dr, Oxford, MS 38655-7900 | 2006-08-21 |
| 1174538508 | Shobha Jagadeesh | Internal Medicine | 144 Oxford Rd, Oxford, CT 06478-1982 | 2006-07-31 |
| 1215953963 | Steven A Herzig | Internal Medicine | 353 Niblick Ln, Oxford, CT 06478-3113 | 2006-07-14 |
| Find all providers in OXFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.