Healthcare Provider Details

I. General information

NPI: 1790825206
Provider Name (Legal Business Name): COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HAMBY RD.
DOBSON NC
27017-8471
US

IV. Provider business mailing address

118 HAMBY RD.
DOBSON NC
27017-8471
US

V. Phone/Fax

Practice location:
  • Phone: 336-401-8400
  • Fax: 336-401-8599
Mailing address:
  • Phone: 336-401-8400
  • Fax: 336-401-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number100131
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D0655018
License Number StateNC
# 9
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number100131
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1922
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerPARTNERS
# 2
Identifier3404386
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier0408756
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerUNITED HEALTH CARE
# 4
Identifier07179
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name: KELLY COLLINS
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 336-401-8405