Provider Demographics
NPI:1962565788
Name:COUNTY OF WILKES
Entity type:Organization
Organization Name:COUNTY OF WILKES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-651-7460
Mailing Address - Street 1:306 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2854
Mailing Address - Country:US
Mailing Address - Phone:336-651-7450
Mailing Address - Fax:336-651-7472
Practice Address - Street 1:306 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2854
Practice Address - Country:US
Practice Address - Phone:336-651-7450
Practice Address - Fax:336-651-7472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WILKES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07095OtherBLUECROSSBLUESHIELD
NC3404397Medicaid