Provider Demographics
NPI:1083779797
Name:COUNTY OF BLADEN OFFICE OF AUDITOR
Entity type:Organization
Organization Name:COUNTY OF BLADEN OFFICE OF AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING TECHNICIAN III
Authorized Official - Prefix:
Authorized Official - First Name:DJUANA
Authorized Official - Middle Name:T
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-872-6209
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:300 MERCER ROAD
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ROAD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-872-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QD0000X
261QF0050X, 261QM2500X, 261QC1500X, 291U00000X, 251B00000X, 261QP2300X, 3336C0002X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No291U00000XLaboratoriesClinical Medical Laboratory
No251B00000XAgenciesCase Management
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404309Medicaid
NC07062OtherBLUE CROSS BLUE SHIELD
NC34D0865177OtherCLIA
NC3404454Medicaid
NC3404309Medicaid