1902993710 NPI number — EAST COAST MEDICAL PLLC

Table of content: (NPI 1902993710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902993710 NPI number — EAST COAST MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST MEDICAL PLLC
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:
1902993710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22545B HWY 17 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-329-0300
Provider Business Mailing Address Fax Number:
910-329-0307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22545B HWY 17 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-329-0300
Provider Business Practice Location Address Fax Number:
910-329-0307
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOCUM
Authorized Official First Name:
LISA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-329-0300

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  39512 , 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: 183715 . This is a "MEDCOST GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00310136 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5901781 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017N3 . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com