Provider Demographics
NPI:1104967975
Name:RICHMOND COUNTY GOVERNMENT
Entity type:Organization
Organization Name:RICHMOND COUNTY GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-997-8300
Mailing Address - Street 1:127 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3567
Mailing Address - Country:US
Mailing Address - Phone:910-997-8300
Mailing Address - Fax:910-997-8336
Practice Address - Street 1:127 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3567
Practice Address - Country:US
Practice Address - Phone:910-997-8300
Practice Address - Fax:910-997-8336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherCLINICAL SERVICES
NC600000678Medicare ID - Type UnspecifiedCLINICAL SERVICES