1164476834 NPI number — CAROLINAEAST MEDICAL CENTER

Table of content: (NPI 1164476834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164476834 NPI number — CAROLINAEAST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAEAST MEDICAL CENTER
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:
CAROLINAEAST PRIMARY CARE
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:
1164476834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 529
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28586-0529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-244-1785
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 FARM LIFE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28586-7673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-244-1785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERRON
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO/ VP FINANCE
Authorized Official Telephone Number:
252-633-8880

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  H0201 , 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: 0254H . This is a "NCBCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890254H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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