1609822287 NPI number — EASTERN CAROLINA MEDICAL CENTER, PC

Table of content: (NPI 1609822287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609822287 NPI number — EASTERN CAROLINA MEDICAL CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN CAROLINA MEDICAL CENTER, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609822287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27504-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-894-5787
Provider Business Mailing Address Fax Number:
919-207-2039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27504-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-894-5787
Provider Business Practice Location Address Fax Number:
919-207-2039
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VYAS
Authorized Official First Name:
PANKAJ
Authorized Official Middle Name:
KIRTIKANT
Authorized Official Title or Position:
OWNER & PRESIDENT
Authorized Official Telephone Number:
919-894-5787

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  41017 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 890164N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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