1134176506 NPI number — CHARLES D GODWIN

Table of content: (NPI 1134176506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134176506 NPI number — CHARLES D GODWIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES D GODWIN
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:
EASTERN CAROLINA PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
3
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:
1134176506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 VILLAGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENT WOODS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-637-7300
Provider Business Mailing Address Fax Number:
252-637-1772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 VILLAGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENT WOODS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-637-7300
Provider Business Practice Location Address Fax Number:
252-637-1772
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOLK
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
252-637-7300

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  33666 , 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: 8936034 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164496592 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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