BERTIE COUNTY RURAL HEALTH ASSOCIATION NPI 1396886842

NPI Information

NPI: 1396886842
Provider Name: BERTIE COUNTY RURAL HEALTH ASSOCIATION
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 34D2203824

Address:
104 RHODES AVENUE
WINDSOR, NC
ZIP 27983
Phone: (252) 794-3042
Get Directions

BERTIE COUNTY RURAL HEALTH ASSOCIATION is a federally qualified health center (fqhc) clinic center in Windsor, NC. BERTIE COUNTY RURAL HEALTH ASSOCIATION NPI is 1396886842. The provider is registered as an organization entity type.

The provider's business location address is:

104 RHODES AVENUE
WINDSOR, NC
ZIP 27983-656
Phone: (252) 794-3042
Fax: (252) 794-2911

The provider's authorized official is Shavonda Pugh .
The authorized official title is Ceo and has the following contact phone number (252) 794-1835.

The CLIA number assigned to this NPI record is 34D2203824 - other - bertie county with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/9/2007 and was last updated on 6/24/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	3336C0002X	Pharmacy	Clinic Pharmacy	No
2	174400000X	Specialist		No
3	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	341825	OTHER	NORTH CAROLINA	MEDICARE
2	344512A	MEDICAID	NORTH CAROLINA
3	344512C	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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