Tyrrell County Rural Health Association, Inc.
Organization Active NPI Rural Health Clinic/Center · Columbia, NC
NPI 1477583102 · NPPES record last updated Jul 16, 2018
Key facts
- NPI
- 1477583102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.
- Practice address
- 208 North Broad Street
Columbia, NC 27925 - Phone
- (252) 796-0689
- Fax
- (252) 796-0690
- NPI assigned
- Jul 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Irene Leibensperger-Cavall, FNP
- Title
- Medical Director
- Phone
- (252) 796-0689
Owners & managing parties with NPI records 1
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0242518 | Columbia Medical Center | Certificate of waiver | Mar 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 343923
- Legal name
- TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.
- Doing business as
- COLUMBIA MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 20, 1992
- Last certification
- Sep 14, 2021
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 20, 1992 in NC
- Enrollment address
- 208 N Broad Street
Columbia, NC 27925-9705
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Frank Hughes |
Corporate Director |
Jan 1, 2024 | 100% |
| Operational/Managerial Control |
Jan 1, 2024 | 100% | |
| Irene Liebensperger-Cavall |
Corporate Director |
May 1, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041108001233 | NC | Part B Supplier - Clinic/Group Practice | 7911960257 |
Receives reassigned benefits from 2 practitioners Practice locations: Columbia, NC |
| O20101201000681 | NC | Part a Provider - Rural Health Clinic | 7911960257 | Practice locations: Columbia, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | NC | Yes |
Addresses
Primary practice location
208 North Broad Street
Columbia, NC 27925
Mailing address
208 North Broad St
Columbia, NC 27925-9705
Phone (252) 796-0689
Other names
- DBA - Columbia Medical Center
Other providers in Columbia, NC
- Rpa Healthcare
- Jasmine Spruill
- This Is Life
- Tideland Mental Health Center- Columbia Office
- Tyrrell County Ambulance
- Tyrrell County Schools
All providers in Columbia, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.