Provider Demographics
| NPI: | 1831249986 |
|---|---|
| Name: | CUMBERLAND COUNTY HEALTH DEPT |
| Entity type: | Organization |
| Organization Name: | CUMBERLAND COUNTY HEALTH DEPT |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | BILLING SUPERVISOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TINA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MAY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 910-433-3809 |
| Mailing Address - Street 1: | 1235 RAMSEY STREET |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FAYETTEVILLE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28301-4401 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 910-433-3600 |
| Mailing Address - Fax: | 910-321-7103 |
| Practice Address - Street 1: | 1235 RAMSEY STREET |
| Practice Address - Street 2: | |
| Practice Address - City: | FAYETTEVILLE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28301-4401 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 910-433-3600 |
| Practice Address - Fax: | 910-321-7103 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | COUNTY OF CUMBERLAND |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-01-11 |
| Last Update Date: | 2023-08-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | 251B00000X, 261Q00000X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X, 291U00000X, 363AM0700X, 363LP0200X, 363LW0102X, 363LX0001X, 251K00000X | |
| 261QP0905X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251K00000X | Agencies | Public Health or Welfare | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | |
| No | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | |
| No | 261QP0905X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | ||
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 0705C | Other | BLUE CROSS BLUE SHIELD |
| NC | 3404429 | Medicaid | |
| NC | 3403056 | Medicaid | |
| NC | 3403056 | Medicaid | |
| NC | 0241 | Medicare ID - Type Unspecified | MEDICARE |
