Provider Demographics
NPI:1619043544
Name:COUNTY OF COLUMBUS OFFICE OF ACCOUNTANT
Entity Type:Organization
Organization Name:COUNTY OF COLUMBUS OFFICE OF ACCOUNTANT
Other - Org Name:COLUMBUS COUNTY HEALTH DEPARMENT CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSHCA
Authorized Official - Phone:910-640-6615
Mailing Address - Street 1:304 JEFFERSON ST
Mailing Address - Street 2:BOX 810
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3602
Mailing Address - Country:US
Mailing Address - Phone:910-640-6615
Mailing Address - Fax:910-640-1088
Practice Address - Street 1:304 JEFFERSON ST
Practice Address - Street 2:BOX 810
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3602
Practice Address - Country:US
Practice Address - Phone:910-640-6615
Practice Address - Fax:910-640-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QD0000X, 261QH0100X, 261QM2500X, 261QP0905X, 261QP2300X
NC34D0655436291U00000X
NC048103336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404487Medicaid