Provider Demographics
NPI:1356498794
Name:COUNTY OF BRUNSWICK
Entity type:Organization
Organization Name:COUNTY OF BRUNSWICK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1910-253-2250
Mailing Address - Street 1:75 STAMP ACT DR
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8320
Mailing Address - Country:US
Mailing Address - Phone:910-253-5788
Mailing Address - Fax:910-253-2875
Practice Address - Street 1:75 STAMP ACT DR
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8320
Practice Address - Country:US
Practice Address - Phone:910-253-5788
Practice Address - Fax:910-253-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC194741OtherMEDCOST FLU
NC3404476Medicaid
NC070900OtherBC BS FLU
NC80888OtherCIGNA FLU
NC=========OtherOTHER INSURANCES FLU
NC194741OtherMEDCOST FLU
NC=========OtherCAPE FLU
NC=========OtherCAPE FLU
NC=========OtherUNITED HEALTHCARE FLU