Provider Demographics
NPI:1871594622
Name:COUNTY OF WAYNE
Entity type:Organization
Organization Name:COUNTY OF WAYNE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-731-1226
Mailing Address - Street 1:301 N HERMAN ST
Mailing Address - Street 2:BOX CC
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-2973
Mailing Address - Country:US
Mailing Address - Phone:919-731-1000
Mailing Address - Fax:919-731-1232
Practice Address - Street 1:301 N HERMAN ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2973
Practice Address - Country:US
Practice Address - Phone:919-731-1000
Practice Address - Fax:919-731-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7221251B00000X, 261QC1500X, 261QD0000X, 261QF0050X, 261QM2500X, 261QP0905X, 261QP2300X, 291U00000X
NC038733336C0002X
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
NC3404396Medicaid
NC07114OtherBLUE CROSS - BLUE SHIELD
NC3404479Medicaid
NC34D0865177OtherNC STATE LAB
NC3404396Medicaid