Provider Demographics
NPI:1952705717
Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:336-318-6200
Mailing Address - Street 1:2222 S FAYETTEVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-7368
Mailing Address - Country:US
Mailing Address - Phone:336-318-6227
Mailing Address - Fax:336-318-6234
Practice Address - Street 1:2222 S FAYETTEVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-7368
Practice Address - Country:US
Practice Address - Phone:336-318-6227
Practice Address - Fax:336-318-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local