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General NPI Number Information
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NPI Number | 1477583102
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Entity Type | Organization
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Legal Business Name | TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 208 NORTH BROAD STREET
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City | COLUMBIA
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State | NC
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Zip | 27925
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Country | US
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Telephone | 252-796-0689
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Fax | 252-796-0690
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Provider Business Mailing Address
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Address Line | 208 NORTH BROAD ST
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City | COLUMBIA
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State | NC
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Zip | 27925-9705
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Country | US
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Telephone | 252-796-0689
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Fax | 252-796-0690
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | IRENE LEIBENSPERGER-CAVALL
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Credential | FNP
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Telephone | 252-796-0689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | NC
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