Healthcare Provider Details

I. General information

NPI: 1740384239
Provider Name (Legal Business Name): EAST CAROLINA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/28/2008
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: 252-209-5405
Mailing address:
  • Phone: 252-209-5404
  • Fax: 252-209-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JON GRAHAM
Title or Position: C.F.O.
Credential:
Phone: 252-209-3610