MEDICARE: ALBEMARLE REGIONAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	291U00000X	Clinical Medical Laboratory	34D0668425	NC
3	3336C0002X	Clinic Pharmacy
4	261QM2500X	Medical Specialty Clinic/Center
5	251B00000X	Case Management Agency
6	261QC1500X	Community Health Clinic/Center
7	261QD0000X	Dental Clinic/Center
8	261QF0050X	Non-Surgical Family Planning Clinic/Center
9	261QM1000X	Migrant Health Clinic/Center
10	261QP0905X	State or Local Public Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	34D0668425	OTHER	NC	CLIA
3	34D2241744	OTHER	NC	CLIA

General Provider Information

NPI Number	:	1265513329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE REGIONAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27907-0189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 US 158 E
Second Line	:	BLDG B
City	:	CAMDEN
State	:	NC
Zip	:	27921
Country	:	US
Telephone Number	:	252-338-4404
Fax Number	:

Authorized Official
Title or Position	:	HEALTH DIRECTOR
Name	:	MRS. ASHLEY STOOP
Credential	:	MPH
Telephone Number	:	252-338-4491

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/18/2022

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Directions to “ALBEMARLE REGIONAL HEALTH SERVICES ” Practice Location

Language	Start Address	Practice Location

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