Healthcare Provider Details

I. General information

NPI: 1154419604
Provider Name (Legal Business Name): WARREN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

IV. Provider business mailing address

544 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-1185
  • Fax: 252-257-2897
Mailing address:
  • Phone: 252-257-1185
  • Fax: 252-257-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34DO865330
License Number StateNC

VIII. Authorized Official

Name: GEORGE A SMITH
Title or Position: INTERIM HEALTH DIRECTOR
Credential:
Phone: 252-257-1538