MEDICARE: COUNTY OF WAYNE

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	3336C0002X	Clinic Pharmacy	03873	NC
2	251B00000X	Case Management Agency	7221	NC
3	261QM2500X	Medical Specialty Clinic/Center	7221	NC
4	261QD0000X	Dental Clinic/Center	7221	NC
5	291U00000X	Clinical Medical Laboratory	7221	NC
6	261QF0050X	Non-Surgical Family Planning Clinic/Center	7221	NC
7	261QP0905X	State or Local Public Health Clinic/Center	7221	NC

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	07114	OTHER	NC	BLUE CROSS - BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	34D0865177	OTHER	NC	NC STATE LAB

General Provider Information

NPI Number	:	1871594622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WAYNE

Provider Business Mailing Address
First Line	:	1560 CLINGMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2162
Country	:	US
Telephone Number	:	919-731-1000
Fax Number	:	919-705-6546

Provider Business Practice Location Address
First Line	:	1560 CLINGMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2162
Country	:	US
Telephone Number	:	919-731-1000
Fax Number	:	373-705-6546

Authorized Official
Title or Position	:	MEDICAL RECORDS MANAGER
Name	:	DAWN KAUPA
Credential	:
Telephone Number	:	919-731-1284

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/07/2026

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Directions to “COUNTY OF WAYNE ” Practice Location

Language	Start Address	Practice Location

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