Healthcare Provider Details

I. General information

NPI: 1689726101
Provider Name (Legal Business Name): OCRACOKE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BACK ROAD
OCRACOKE NC
27960-0543
US

IV. Provider business mailing address

PO BOX 543 305 BACK ROAD
OCRACOKE NC
27960-0543
US

V. Phone/Fax

Practice location:
  • Phone: 252-928-1511
  • Fax: 252-928-7391
Mailing address:
  • Phone: 252-928-1511
  • Fax: 252-928-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1689726101
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier341014
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE FQHC

VIII. Authorized Official

Name: CHERYL L BALLANCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-928-1511