Provider Demographics
NPI:1770610602
Name:COUNTY OF EDGECOMBE OFFICE OF AUDITOR
Entity type:Organization
Organization Name:COUNTY OF EDGECOMBE OFFICE OF AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BRUMFIELD
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-824-3654
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-0100
Mailing Address - Country:US
Mailing Address - Phone:252-641-7511
Mailing Address - Fax:252-641-7565
Practice Address - Street 1:122 E SAINT JAMES ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5016
Practice Address - Country:US
Practice Address - Phone:252-641-7531
Practice Address - Fax:252-641-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 251B00000X, 261Q00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP2300X, 363L00000X, 261QP0905X
NC34DO865324291U00000X
NC047953336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
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
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0706AOtherBLUE CROSS BLUE SHIELD
NC3404449Medicaid
NC3404333Medicaid
NC3404333Medicaid
NC3404449Medicaid
NC=========OtherOTHER INSURANCE