Provider Demographics
NPI:1609912096
Name:COUNTY OF JACKSON
Entity Type:Organization
Organization Name:COUNTY OF JACKSON
Other - Org Name:JACKSON COUNTY HLTH DEPT CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPA
Authorized Official - Phone:828-586-8994
Mailing Address - Street 1:538 SCOTTS CREEK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5281
Mailing Address - Country:US
Mailing Address - Phone:828-586-8994
Mailing Address - Fax:828-631-3617
Practice Address - Street 1:538 SCOTTS CREEK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5281
Practice Address - Country:US
Practice Address - Phone:828-586-8994
Practice Address - Fax:828-631-3617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JACKSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
NC07113OtherBLUE CROSS INSURANCE
NC3404350Medicaid
NC34D0685734OtherCLIA
NC3404350Medicaid