1134254527 NPI number — GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134254527 NPI number — GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
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:
Provider Other Organization Name Type Code:
6
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:
1134254527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 E WENDOVER AVE
Provider Second Line Business Mailing Address:
INTERNATIONAL TRAVEL ADMINISTRATION
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-6713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-641-7777
Provider Business Mailing Address Fax Number:
336-641-6971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E GREEN DR
Provider Second Line Business Practice Location Address:
INTERNATIONAL TRAVEL SERVICES
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27260-6707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-845-7990
Provider Business Practice Location Address Fax Number:
336-845-7987
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
HARVETTE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
336-641-7777

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 291U00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 291U00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 07124 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS34604210001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-07677 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".