MEDICARE: BERTIE COUNTY RURAL HEALTH ASSOCIATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0002X	Clinic Pharmacy
2	174400000X	Specialist
3	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	341825	OTHER	NC	MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396886842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERTIE COUNTY RURAL HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 628
Second Line	:
City	:	WINDSOR
State	:	NC
Zip	:	27983-0628
Country	:	US
Telephone Number	:	252-794-3042
Fax Number	:	252-794-2911

Provider Business Practice Location Address
First Line	:	104 RHODES AVENUE
Second Line	:
City	:	WINDSOR
State	:	NC
Zip	:	27983-9656
Country	:	US
Telephone Number	:	252-794-3042
Fax Number	:	252-794-2911

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHAVONDA PUGH
Credential	:	MBA
Telephone Number	:	252-794-1835

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	12/04/2025

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