Provider Demographics
NPI:1659597078
Name:GATES COUNTY RURAL HEALTH SERVICE
Entity type:Organization
Organization Name:GATES COUNTY RURAL HEALTH SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-357-1132
Mailing Address - Street 1:25 MEDICAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NC
Mailing Address - Zip Code:27937-9816
Mailing Address - Country:US
Mailing Address - Phone:252-357-1132
Mailing Address - Fax:252-357-1885
Practice Address - Street 1:25 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:GATES
Practice Address - State:NC
Practice Address - Zip Code:27937-9816
Practice Address - Country:US
Practice Address - Phone:252-357-1132
Practice Address - Fax:252-357-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty