Provider Demographics
NPI:1205062551
Name:COUNTY OF ANSON
Entity type:Organization
Organization Name:COUNTY OF ANSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROCESSING ASST V
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-694-5188
Mailing Address - Street 1:110 E ASHE ST
Mailing Address - Street 2:P. O BOX 473
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2702
Mailing Address - Country:US
Mailing Address - Phone:704-694-5188
Mailing Address - Fax:704-694-9067
Practice Address - Street 1:110 E ASHE ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2702
Practice Address - Country:US
Practice Address - Phone:704-694-5188
Practice Address - Fax:704-694-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700311Medicaid