Provider Demographics
NPI:1861529653
Name:SCOTLAND COUNTY
Entity type:Organization
Organization Name:SCOTLAND COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:910-277-2440
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-0069
Mailing Address - Country:US
Mailing Address - Phone:910-277-2440
Mailing Address - Fax:910-277-2450
Practice Address - Street 1:1405 WEST BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-0069
Practice Address - Country:US
Practice Address - Phone:910-277-2440
Practice Address - Fax:910-277-2450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTLAND COUNTY HEALT DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2013-11-01
Deactivation Date:2007-06-05
Deactivation Code:
Reactivation Date:2009-01-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC600001651OtherMEDICARE RAILROAD
2803276Medicare UPIN