Provider Demographics
NPI:1720161334
Name:COUNTY OF MACON
Entity Type:Organization
Organization Name:COUNTY OF MACON
Other - Org Name:MACON COUNTY PUBLIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-349-2420
Mailing Address - Street 1:1830 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-6778
Mailing Address - Country:US
Mailing Address - Phone:828-349-2081
Mailing Address - Fax:824-524-6154
Practice Address - Street 1:1830 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-6778
Practice Address - Country:US
Practice Address - Phone:828-349-2081
Practice Address - Fax:824-524-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404356Medicaid
07258OtherBCBS
=========01OtherHUMANA INSURANCE
NC3404356Medicaid
07258OtherBCBS
=========004OtherTRICARE INSURANCE
=========003OtherTRICARE INSURANCE
=========OtherFEDERAL TAX ID#