Provider Demographics
NPI:1477692606
Name:COUNTY OF ONSLOW
Entity Type:Organization
Organization Name:COUNTY OF ONSLOW
Other - Org Name:ONSLOW COUNTY HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-455-3404
Mailing Address - Street 1:328 NEW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4756
Mailing Address - Country:US
Mailing Address - Phone:910-455-3404
Mailing Address - Fax:910-937-1594
Practice Address - Street 1:612 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5311
Practice Address - Country:US
Practice Address - Phone:910-347-2154
Practice Address - Fax:910-347-3165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ONSLOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 251B00000X, 261QC1500X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X
NC34D0989962291U00000X
NC34D0865177291U00000X
NC041733336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
020GMOtherBLUE CROSS BLUE SHIELD
NC3404367Medicaid
07172OtherBLUE CROSS BLUE SHIELD
07172OtherBLUE CROSS BLUE SHIELD
NC3404367Medicaid