1669912333 NPI number — ALEXANDER COUNTY

Table of content: (NPI 1669912333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669912333 NPI number — ALEXANDER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDER 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:
ALEXANDER COUNTY HEALTH DEPARTMENT DENTAL CLINIC
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:
1669912333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
338 1ST AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLORSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28681-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-632-9704
Provider Business Mailing Address Fax Number:
828-632-9008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
338 1ST AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-632-9704
Provider Business Practice Location Address Fax Number:
828-632-9008
Provider Enumeration Date:
03/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WHISNANT
Authorized Official First Name:
LEEANNE
Authorized Official Middle Name:
JAYNES
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
828-632-9704

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3404302 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020 UK . This is a "BLUE CROSS BLUE SHIELD OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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