Provider Demographics
NPI:1508887076
Name:COUNTY OF PENDER
Entity Type:Organization
Organization Name:COUNTY OF PENDER
Other - Org Name:PENDER COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:910-259-1499
Mailing Address - Street 1:803 S. WALKER STREET
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5001
Mailing Address - Country:US
Mailing Address - Phone:910-259-1474
Mailing Address - Fax:910-259-1258
Practice Address - Street 1:803 S. WALKER STREET
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5001
Practice Address - Country:US
Practice Address - Phone:910-259-1474
Practice Address - Fax:910-259-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X, 3336C0002X
NC34D0676319291U00000X
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
NC3404371Medicaid
NC3404424Medicaid
NC0721HOtherBCBSNC
NC3404424Medicaid