Provider Demographics
NPI:1205955531
Name:COUNTY OF MADISON
Entity type:Organization
Organization Name:COUNTY OF MADISON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPA
Authorized Official - Phone:828-649-3531
Mailing Address - Street 1:493 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-3901
Mailing Address - Country:US
Mailing Address - Phone:828-649-3531
Mailing Address - Fax:828-649-9078
Practice Address - Street 1:493 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-3901
Practice Address - Country:US
Practice Address - Phone:828-649-3531
Practice Address - Fax:828-649-9078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MADISON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherOTHER INSURANCE
NC=========OtherBLUE CROSS BLUE SHIELD
NC2803928Medicare ID - Type Unspecified