Provider Demographics
NPI:1861531626
Name:ALBEMARLE REGIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:ALBEMARLE REGIONAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:252-334-4404
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27907-0189
Mailing Address - Country:US
Mailing Address - Phone:252-338-4404
Mailing Address - Fax:
Practice Address - Street 1:102 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:252-338-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM1000X, 261QM2500X, 261QP0905X, 261QP2300X, 3336C0002X
NC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Not Answered261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Not Answered261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered3336C0002XSuppliersPharmacyClinic Pharmacy
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404477Medicaid
NC3404477Medicaid