Healthcare Provider Details

I. General information

NPI: 1174585012
Provider Name (Legal Business Name): HEALTHEAST OUTER BANKS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40894 HWY 12
AVON NC
27915
US

IV. Provider business mailing address

40894 HWY 12
AVON NC
27915
US

V. Phone/Fax

Practice location:
  • Phone: 252-995-3073
  • Fax:
Mailing address:
  • Phone: 252-995-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN T. LANIER
Title or Position: VP OF FINANCE FOR EAST CAROLINA HEA
Credential:
Phone: 252-847-7479