Provider Demographics
NPI:1457356651
Name:COUNTY OF BURKE
Entity Type:Organization
Organization Name:COUNTY OF BURKE
Other - Org Name:BURKE COUNTY HEALTH DEPT-CLINIC SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:282-764-9160
Mailing Address - Street 1:700 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6762
Mailing Address - Country:US
Mailing Address - Phone:828-764-9150
Mailing Address - Fax:828-764-9155
Practice Address - Street 1:700 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-6762
Practice Address - Country:US
Practice Address - Phone:828-764-9150
Practice Address - Fax:828-764-9155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BURKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-15
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X, 261QC1500X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X, 3336C0002X
NC34DO865328291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011UXOtherBCBS OF NC
NC3404312Medicaid
NC=========OtherFED TAX ID NUMBER
NC011UXOtherBCBS OF NC