Healthcare Provider Details

I. General information

NPI: 1609912096
Provider Name (Legal Business Name): COUNTY OF JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 SCOTTS CREEK ROAD SUITE 100
SYLVA NC
28779-5281
US

IV. Provider business mailing address

538 SCOTTS CREEK ROAD SUITE 100
SYLVA NC
28779-5281
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-8994
  • Fax: 828-631-3617
Mailing address:
  • Phone: 828-586-8994
  • Fax: 828-631-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier07113
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS INSURANCE
# 2
Identifier3404350
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier34D0685734
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerCLIA

VIII. Authorized Official

Name: MS. PAULA G CARDEN
Title or Position: DIRECTOR
Credential: MSPA
Phone: 828-586-8994