Provider Demographics
NPI:1912259995
Name:ALBEMARLE REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALBEMARLE REGIONAL HEALTH SERVICES
Other - Org Name:INTER-COUNTY PUBLIC TRANSPORTATION AUTHORITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:252-338-4404
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27907-0189
Mailing Address - Country:US
Mailing Address - Phone:252-338-4453
Mailing Address - Fax:252-337-7904
Practice Address - Street 1:110 KITTY HAWK LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6756
Practice Address - Country:US
Practice Address - Phone:252-338-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)