Provider Demographics
NPI:1639244452
Name:COUNTY OF CLEVELAND NORTH CAROLINA
Entity Type:Organization
Organization Name:COUNTY OF CLEVELAND NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-484-5200
Mailing Address - Street 1:200 S POST RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6269
Mailing Address - Country:US
Mailing Address - Phone:980-484-5100
Mailing Address - Fax:980-484-5118
Practice Address - Street 1:200 S POST RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6269
Practice Address - Country:US
Practice Address - Phone:980-484-5100
Practice Address - Fax:980-484-5118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CLEVELAND NORTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60001112Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC2803230Medicare ID - Type Unspecified