Provider Demographics
NPI:1902855786
Name:YANCEY COUNTY PRIMARY CARE CENTER
Entity Type:Organization
Organization Name:YANCEY COUNTY PRIMARY CARE CENTER
Other - Org Name:TOE RIVER HEALTH DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-765-9081
Mailing Address - Street 1:202 MEDICAL CAMPUS DR.
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714
Mailing Address - Country:US
Mailing Address - Phone:828-682-6118
Mailing Address - Fax:828-682-6262
Practice Address - Street 1:202 MEDICAL CAMPUS DR.
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714
Practice Address - Country:US
Practice Address - Phone:828-682-6118
Practice Address - Fax:828-682-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343828AMedicaid
NC343828CMedicaid
NC3404300Medicaid
NC3404484Medicaid