Provider Demographics
NPI:1104319441
Name:MCDOWELL COUNTY
Entity type:Organization
Organization Name:MCDOWELL COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRANSIT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-803-4703
Mailing Address - Street 1:302 ROCKWELL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-9207
Mailing Address - Country:US
Mailing Address - Phone:828-803-4703
Mailing Address - Fax:
Practice Address - Street 1:302 ROCKWELL DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-9207
Practice Address - Country:US
Practice Address - Phone:828-803-4703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDOWELL COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40357203Medicaid