1770852899 NPI number — CAROLINAEAST PHYSICIANS

Table of content: (NPI 1770852899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770852899 NPI number — CAROLINAEAST PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAEAST PHYSICIANS
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:
1770852899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28289-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-633-6730
Provider Business Mailing Address Fax Number:
252-633-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 NEWMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-633-6730
Provider Business Practice Location Address Fax Number:
252-633-6740
Provider Enumeration Date:
12/19/2011

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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