Provider Demographics
NPI:1467507640
Name:COUNTY OF WILSON
Entity Type:Organization
Organization Name:COUNTY OF WILSON
Other - Org Name:WILSON CO. DEPT. OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-237-3141
Mailing Address - Street 1:1801 GLENDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4401
Mailing Address - Country:US
Mailing Address - Phone:252-291-5470
Mailing Address - Fax:252-293-8300
Practice Address - Street 1:1801 GLENDALE DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4401
Practice Address - Country:US
Practice Address - Phone:252-291-5470
Practice Address - Fax:252-293-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QC1500X, 261QF0050X, 261QM2500X, 261QP2300X, 291U00000X, 3336C0002X
NC261QM2500X, 261QP0905X, 291U00000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251K00000XAgenciesPublic Health or Welfare
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404398Medicaid