Provider Demographics
NPI:1063705267
Name:COUNTY OF DAVIDSON
Entity type:Organization
Organization Name:COUNTY OF DAVIDSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, REHS
Authorized Official - Phone:336-242-2349
Mailing Address - Street 1:915 GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292
Mailing Address - Country:US
Mailing Address - Phone:336-242-2300
Mailing Address - Fax:336-242-2485
Practice Address - Street 1:915 N GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2699
Practice Address - Country:US
Practice Address - Phone:336-242-2300
Practice Address - Fax:336-242-2485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DAVIDSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0727FOtherBCBS IMM