Provider Demographics
NPI:1346335312
Name:COUNTY OF CHATHAM
Entity Type:Organization
Organization Name:COUNTY OF CHATHAM
Other - Org Name:CHATHAM COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSA,REHS
Authorized Official - Phone:919-542-8215
Mailing Address - Street 1:1000 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3324
Mailing Address - Country:US
Mailing Address - Phone:919-742-5641
Mailing Address - Fax:919-742-7496
Practice Address - Street 1:1000 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3324
Practice Address - Country:US
Practice Address - Phone:919-742-5641
Practice Address - Fax:919-742-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X
NC34D0674878291U00000X
NC048793336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404419Medicaid
NC0706EOtherBLUE CROSS BLUE SHIELD
NC0706EOtherBLUE CROSS BLUE SHIELD
NC0706EOtherBLUE CROSS BLUE SHIELD