Provider Demographics
NPI:1689726101
Name:OCRACOKE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:OCRACOKE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-928-1511
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:305 BACK ROAD
Mailing Address - City:OCRACOKE
Mailing Address - State:NC
Mailing Address - Zip Code:27960-0543
Mailing Address - Country:US
Mailing Address - Phone:252-928-1511
Mailing Address - Fax:252-928-7391
Practice Address - Street 1:305 BACK ROAD
Practice Address - Street 2:
Practice Address - City:OCRACOKE
Practice Address - State:NC
Practice Address - Zip Code:27960-0543
Practice Address - Country:US
Practice Address - Phone:252-928-1511
Practice Address - Fax:252-928-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689726101Medicaid
NC341014OtherMEDICARE FQHC
NC343893Medicare ID - Type Unspecified