Provider Demographics
NPI:1679576763
Name:COUNTY OF BEAUFORT
Entity type:Organization
Organization Name:COUNTY OF BEAUFORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-946-1902
Mailing Address - Street 1:1436 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3222
Mailing Address - Country:US
Mailing Address - Phone:252-946-1902
Mailing Address - Fax:252-946-8430
Practice Address - Street 1:1436 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3222
Practice Address - Country:US
Practice Address - Phone:252-946-1902
Practice Address - Fax:252-946-8430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BEAUFORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404307Medicaid
NC0728HOtherBLUE CROSS PROVIDER NUMBE
NCP00108404Medicare PIN
NC3404307Medicaid
NC2317902BMedicare PIN