Provider Demographics
NPI:1134295850
Name:COUNTY OF MONTGOMERY
Entity type:Organization
Organization Name:COUNTY OF MONTGOMERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLICUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:910-573-1393
Mailing Address - Street 1:217 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371
Mailing Address - Country:US
Mailing Address - Phone:910-572-1393
Mailing Address - Fax:910-572-8177
Practice Address - Street 1:217 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3200
Practice Address - Country:US
Practice Address - Phone:910-572-1393
Practice Address - Fax:910-572-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP2300X, 261QP0905X
NC34D0675784291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34044438Medicaid
NC3404362Medicaid
NC34044438Medicaid
NC=========OtherOTHER INSURANCE