Provider Demographics
NPI:1639323140
Name:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT
Other - Org Name:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT-IMM
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-223-3908
Mailing Address - Street 1:221 CALLAHAN KOON RD
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-2207
Mailing Address - Country:US
Mailing Address - Phone:828-223-3930
Mailing Address - Fax:828-288-4047
Practice Address - Street 1:221 CALLAHAN KOON RD
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-2207
Practice Address - Country:US
Practice Address - Phone:828-223-3930
Practice Address - Fax:828-288-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2013-06-04
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
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0725WOtherBCBS