Provider Demographics
NPI:1629210752
Name:COUNTY OF BURKE
Entity Type:Organization
Organization Name:COUNTY OF BURKE
Other - Org Name:DBA BURKE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUST
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPH
Authorized Official - Phone:828-439-4413
Mailing Address - Street 1:700 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6762
Mailing Address - Country:US
Mailing Address - Phone:828-439-4400
Mailing Address - Fax:828-439-4444
Practice Address - Street 1:700 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-6762
Practice Address - Country:US
Practice Address - Phone:828-439-4400
Practice Address - Fax:828-439-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2011-06-01
Deactivation Date:2010-03-11
Deactivation Code:
Reactivation Date:2011-06-01
Provider Licenses
StateLicense IDTaxonomies
NC251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404312Medicaid
NC3404312Medicaid