Provider Demographics
NPI:1720177140
Name:COUNTY OF DAVIE OFFICE OF FINANCE AGENT
Entity Type:Organization
Organization Name:COUNTY OF DAVIE OFFICE OF FINANCE AGENT
Other - Org Name:DAVIE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:336-753-6750
Mailing Address - Street 1:154 GOVERNMENT CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028
Mailing Address - Country:US
Mailing Address - Phone:336-753-6750
Mailing Address - Fax:336-751-0335
Practice Address - Street 1:154 GOVERNMENT CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028
Practice Address - Country:US
Practice Address - Phone:336-753-6750
Practice Address - Fax:336-751-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QP0905X, 291U00000X
NC044653336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404330Medicaid