Provider Demographics
NPI:1134279722
Name:ALEXANDER COUNTY
Entity Type:Organization
Organization Name:ALEXANDER COUNTY
Other - Org Name:ALEXANDER COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEEANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHISNANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MS
Authorized Official - Phone:828-632-9704
Mailing Address - Street 1:338 1ST AVE SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-2483
Mailing Address - Country:US
Mailing Address - Phone:828-632-9704
Mailing Address - Fax:828-632-9008
Practice Address - Street 1:338 1ST AVE SW
Practice Address - Street 2:SUITE 1
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2483
Practice Address - Country:US
Practice Address - Phone:828-632-9704
Practice Address - Fax:828-632-9008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXANDER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-12
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0721COtherBCBS
=========OtherTAX ID
NC2803331Medicare ID - Type UnspecifiedMASS IMMUNIZATION CLINIC