Provider Demographics
NPI:1669697108
Name:COUNTY OF ROBESON OFFICE OF TREASURER
Entity type:Organization
Organization Name:COUNTY OF ROBESON OFFICE OF TREASURER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-3404
Mailing Address - Street 1:460 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9494
Mailing Address - Country:US
Mailing Address - Phone:910-608-2100
Mailing Address - Fax:910-608-2102
Practice Address - Street 1:460 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-9494
Practice Address - Country:US
Practice Address - Phone:910-608-2100
Practice Address - Fax:910-608-2102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ROBESON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X, 261QP0905X, 261QP2300X
NC34D0934973291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0273HOtherBLUE CROSS BLUE SHIELD