Provider Demographics
NPI:1427198977
Name:HERTFORD COUNTY PUBLIC HEALTH AUTHORITY
Entity Type:Organization
Organization Name:HERTFORD COUNTY PUBLIC HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:252-358-7833
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27986-0246
Mailing Address - Country:US
Mailing Address - Phone:252-358-7833
Mailing Address - Fax:252-358-7869
Practice Address - Street 1:828 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3263
Practice Address - Country:US
Practice Address - Phone:252-862-4054
Practice Address - Fax:252-862-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700438Medicaid