Healthcare Provider Details

I. General information

NPI: 1629239488
Provider Name (Legal Business Name): EAST CAROLINA HEALTH-CHOWAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VIRGINIA RD
EDENTON NC
27932-9668
US

IV. Provider business mailing address

PO BOX 569
EDENTON NC
27932-0569
US

V. Phone/Fax

Practice location:
  • Phone: 252-482-2116
  • Fax: 252-482-7631
Mailing address:
  • Phone: 252-482-2116
  • Fax: 252-482-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFERY N. SACKRISON
Title or Position: PRESIDENT
Credential:
Phone: 252-482-6268