Provider Demographics
NPI:1669539326
Name:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LOCAL PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-223-3908
Mailing Address - Street 1:221 CALLAHAN KOON RD
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-2207
Mailing Address - Country:US
Mailing Address - Phone:828-223-3908
Mailing Address - Fax:828-288-4047
Practice Address - Street 1:161 WALKER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-9433
Practice Address - Country:US
Practice Address - Phone:828-894-8271
Practice Address - Fax:828-894-8678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTHERFORD-POLK-MCDOWELL DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404375Medicaid