Basic Information
| Provider Information | |||||||||
| NPI: | 1851677587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PITT COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 GOVERNMENT CIR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278348198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529022445 | ||||||||
| FaxNumber: | 2524131396 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 GOVERNMENT CIR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278348198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529022445 | ||||||||
| FaxNumber: | 2524131396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2011 | ||||||||
| LastUpdateDate: | 10/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2529022445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | 34044463 | 05 | NC | MEDICAID | 0722Q | 01 | NC | BLUE CROSS BLUE SHEILD OF NC | OTHER | 7149454 | 01 | AETNA | OTHER |