MEDICARE: COUNTY OF HALIFAX

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	3416L0300X	Land Ambulance		NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590002759	OTHER	NC	RAIL ROAD 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	07232	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730261348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF HALIFAX

Provider Business Mailing Address
First Line	:	PO BOX 2425
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-5602
Country	:	US
Telephone Number	:	252-467-2635
Fax Number	:	252-977-7099

Provider Business Practice Location Address
First Line	:	2420 PROFESSIONAL DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2239
Country	:	US
Telephone Number	:	252-467-2635
Fax Number	:	252-977-7099

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER JOYNER
Credential	:
Telephone Number	:	252-977-1335

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/19/2010

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Directions to “COUNTY OF HALIFAX ” Practice Location

Language	Start Address	Practice Location

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