Provider Demographics
NPI:1427188176
Name:SCOTLAND COUNTY
Entity Type:Organization
Organization Name:SCOTLAND COUNTY
Other - Org Name:SCOTLAND COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:910-277-2440
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-0069
Mailing Address - Country:US
Mailing Address - Phone:910-277-2440
Mailing Address - Fax:910-277-2450
Practice Address - Street 1:1405 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-9170
Practice Address - Country:US
Practice Address - Phone:910-277-2440
Practice Address - Fax:910-277-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QC1500X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X
NC03447291U00000X
NC34D06914933336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
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
NC3404383Medicaid
NC07167OtherBCBS
NC07167OtherBCBS
NC600001651Medicare ID - Type UnspecifiedMEDICARE R R
NC07167OtherBCBS