Organization
BERTIE COUNTY RURAL HEALTH ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAVONDA PUGH MBA (CEO)
(252) 794-1835
Entity
Organization
Contact information
Practice address
104 RHODES AVENUE, WINDSOR, NC 27983-9656
(252) 794-3042
(252) 794-2911
Mailing address
PO BOX 628, WINDSOR, NC 27983-0628
(252) 794-3042
(252) 794-2911
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341825
MEDICARE
NC
05
—
344512A
—
NC
05
—
344512C
—
NC
Enumeration date
02/09/2007
Last updated
12/04/2025
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