CRAVEN COUNTY

Provider Demographics

• NPI: 1295801827
• Name: CRAVEN COUNTY
• Entity type: Organization
• Organization Name: CRAVEN COUNTY
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CRAVEN COUNTY HEALTH DIRECTOR
• Authorized Official - Prefix: MR
• Authorized Official - First Name: DAVID
• Authorized Official - Middle Name: SCOTT
• Authorized Official - Last Name: HARRELSON
• Authorized Official - Phone: 252-636-4920
• Mailing Address - Street 1: P.O. DRAWER 12610
• Mailing Address - City: NEW BERN
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28561-2610
• Mailing Address - Country: US
• Mailing Address - Phone: 252-636-4920
• Mailing Address - Fax: 252-636-4970
• Practice Address - Street 1: 2818 NEUSE BLVD
• Practice Address - City: NEW BERN
• Practice Address - State: NC
• Practice Address - Zip Code: 28560-2610
• Practice Address - Country: US
• Practice Address - Phone: 252-636-4920
• Practice Address - Fax: 252-636-4970
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: CRAVEN COUNTY
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-11-27
• Last Update Date: 2016-04-12

Provider Licenses

State	License ID	Taxonomies
NC	34DOZ46490	291U00000X
		261QD0000X, 261QF0050X, 261QM2500X, 261QC1500X, 3336C0002X, 261QF0400X, 261QP0905X, 3336C0002X, 251S00000X
NC		261QP2300X, 261QP0905X, 251B00000X, 261QC1500X, 261QP0905X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QP0905X	Ambulatory Health Care Facilities	Clinic/Center	Public Health, State or Local
No	291U00000X	Laboratories	Clinical Medical Laboratory
No	261QD0000X	Ambulatory Health Care Facilities	Clinic/Center	Dental
No	261QF0050X	Ambulatory Health Care Facilities	Clinic/Center	Family Planning, Non-Surgical
No	261QM2500X	Ambulatory Health Care Facilities	Clinic/Center	Medical Specialty
No	261QC1500X	Ambulatory Health Care Facilities	Clinic/Center	Community Health
No	3336C0002X	Suppliers	Pharmacy	Clinic Pharmacy
No	261QP2300X	Ambulatory Health Care Facilities	Clinic/Center	Primary Care
No	251B00000X	Agencies	Case Management
No	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)
No	251S00000X	Agencies	Community/Behavioral Health

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	07077	Other	NC BLUE CROSS BLUE SHIELD
NC	07077	Other	BCBS OF NC
NC	3404428	Medicaid
NC	6005559	Other	MEDICAID-MENTAL HEALTH
NC	3404325	Medicaid
NC	3404325	Other	MEDICAID
NC	6005559	Medicaid
NC	6005559	Other	MEDICAID-MENTAL HEALTH
	07077	Other	NC BLUE CROSS BLUE SHIELD
NC	2803038A	Medicare PIN
NC	2803038A	Medicare PIN