Provider Demographics
NPI:1669539458
Name:COUNTY OF WILKES
Entity type:Organization
Organization Name:COUNTY OF WILKES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, EMT-P
Authorized Official - Phone:336-651-7363
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0187
Mailing Address - Country:US
Mailing Address - Phone:336-651-7365
Mailing Address - Fax:336-651-7500
Practice Address - Street 1:1372 WEST D ST
Practice Address - Street 2:COMMUNITY SERVICE BUILDING
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-0187
Practice Address - Country:US
Practice Address - Phone:336-651-7365
Practice Address - Fax:336-651-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0723POtherBCBSNC
NC3406633Medicaid
NC0723POtherBCBSNC