Provider Demographics
NPI:1043599376
Name:BRUNSWICK COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BRUNSWICK COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:910-253-2250
Mailing Address - Street 1:25 COURTHOUSE DR., NE
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-0009
Mailing Address - Country:US
Mailing Address - Phone:910-253-2250
Mailing Address - Fax:910-253-2355
Practice Address - Street 1:25 COURTHOUSE DR. NE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0009
Practice Address - Country:US
Practice Address - Phone:910-253-2250
Practice Address - Fax:910-253-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133V00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3440476Medicaid
NC3440476Medicaid