1306843107 NPI number — COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT

Table of content: (NPI 1306843107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306843107 NPI number — COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
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:
SURRY COUNTY EMERGENCY SERVICES
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:
1306843107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1218 STATE ST
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27030-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-783-9000
Provider Business Mailing Address Fax Number:
336-783-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1218 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-783-9000
Provider Business Practice Location Address Fax Number:
336-783-9010
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
336-783-9000

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1204 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590921218 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: V187AMB . This is a "PARTNERS INS & MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1204 . This is a "ALL OTHER INSURANCE CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009010246 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 0723C . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3406709 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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