Healthcare Provider Details

I. General information

NPI: 1770728065
Provider Name (Legal Business Name): EAST CAROLINA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ACADEMY ST S
AHOSKIE NC
27910-3264
US

IV. Provider business mailing address

PO BOX 1385
AHOSKIE NC
27910-1385
US

V. Phone/Fax

Practice location:
  • Phone: 252-209-5404
  • Fax:
Mailing address:
  • Phone: 252-209-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JON GRAHAM
Title or Position: CFO
Credential:
Phone: 252-209-3610