1164143996 NPI number — MECKLENBURG COUNTY

Table of content: (NPI 1164143996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164143996 NPI number — MECKLENBURG COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MECKLENBURG COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MECKLENBURG COUNTY HEALTH DEPT - NORTHEAST CAMPUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164143996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 BILLINGSLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-314-9126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 STITT ROAD
Provider Second Line Business Practice Location Address:
MECKLENBURG COUNTY PUBLIC HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-336-6400
Provider Business Practice Location Address Fax Number:
704-432-0217
Provider Enumeration Date:
09/09/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
RAYNARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
980-579-0671

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972645422 . This is a "NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".