Provider Demographics
NPI:1104026673
Name:GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARVETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-641-7777
Mailing Address - Street 1:201 N EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2221
Mailing Address - Country:US
Mailing Address - Phone:336-641-7777
Mailing Address - Fax:336-641-6971
Practice Address - Street 1:201 N EUGENE ST
Practice Address - Street 2:PHARMACY GUILFORD CENTER
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2221
Practice Address - Country:US
Practice Address - Phone:336-641-7777
Practice Address - Fax:336-641-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X, 261QP0905X
NC090243336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
3427829OtherNCPDP GUILFORD CENTER
NCAS34604210001OtherCIGNA HEALTHCARE
NC01-07677OtherUNITED HEALTHCARE
NC07124OtherBLUE CROSS BLUE SHIELD