Provider Demographics
NPI:1053572131
Name:BERTIE COUNTY RURAL HEALTH
Entity type:Organization
Organization Name:BERTIE COUNTY RURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-794-1835
Mailing Address - Street 1:104 RHODES AVE
Mailing Address - Street 2:PO BOX 628
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-9656
Mailing Address - Country:US
Mailing Address - Phone:252-794-1835
Mailing Address - Fax:252-794-2911
Practice Address - Street 1:104 RHODES AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9656
Practice Address - Country:US
Practice Address - Phone:252-794-1835
Practice Address - Fax:252-794-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2804220Medicare PIN