Provider Demographics
NPI:1629123211
Name:COUNTY OF HAYWOOD
Entity Type:Organization
Organization Name:COUNTY OF HAYWOOD
Other - Org Name:HAYWOOD COUNTY HHSA-DENTAL OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN C, MPA
Authorized Official - Phone:828-452-6675
Mailing Address - Street 1:157 PARAGON PARKWAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:828-452-6701
Mailing Address - Fax:828-452-6619
Practice Address - Street 1:157 PARAGON PARKWAY
Practice Address - Street 2:SUITE 700
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-452-6701
Practice Address - Fax:828-452-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404344Medicaid
NC=========OtherTAX ID #
NC031E3OtherBLUE CROSS BLUE SHIELD