Healthcare Provider Details

I. General information

NPI: 1609822287
Provider Name (Legal Business Name): EASTERN CAROLINA MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
BENSON NC
27504-1177
US

IV. Provider business mailing address

1 MEDICAL DR
BENSON NC
27504-1177
US

V. Phone/Fax

Practice location:
  • Phone: 919-894-5787
  • Fax: 919-207-2039
Mailing address:
  • Phone: 919-894-5787
  • Fax: 919-207-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number41017
License Number StateNC

VIII. Authorized Official

Name: DR. PANKAJ KIRTIKANT VYAS
Title or Position: OWNER & PRESIDENT
Credential: M.D.
Phone: 919-894-5787