Provider Demographics
NPI:1790825206
Name:COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Entity Type:Organization
Organization Name:COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Other - Org Name:SURRY COUNTY HEALTH & NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:STOPYRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-401-8400
Mailing Address - Street 1:118 HAMBY RD.
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8471
Mailing Address - Country:US
Mailing Address - Phone:336-401-8400
Mailing Address - Fax:336-401-8599
Practice Address - Street 1:118 HAMBY RD.
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8471
Practice Address - Country:US
Practice Address - Phone:336-401-8400
Practice Address - Fax:336-401-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100131251K00000X, 261Q00000X
NC261QC1500X, 261QD0000X, 261QF0050X
261QM2500X, 261QP2300X
NC34D0655018291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0408756OtherUNITED HEALTH CARE
NC07179OtherBCBS
NC1922OtherPARTNERS
NC3404386Medicaid
NC2330314Medicare PIN
NC2803717Medicare PIN