Provider Demographics
NPI:1922164342
Name:COUNTY OF GREENE
Entity Type:Organization
Organization Name:COUNTY OF GREENE
Other - Org Name:GREENE COUNTY DEPARTMENT OF PUBLIC HEALTH - CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:SPENCE
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-747-8183
Mailing Address - Street 1:227 KINGOLD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1303
Mailing Address - Country:US
Mailing Address - Phone:252-747-8181
Mailing Address - Fax:252-747-8946
Practice Address - Street 1:227 KINGOLD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X
NC34D0865324291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
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
NC0721QOtherBCBS PROVIDER ID
NC3404442Medicaid