Healthcare Provider Details

I. General information

NPI: 1205253853
Provider Name (Legal Business Name): ECU PHYSICAL MEDICINE AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MEDICAL DR
GREENVILLE NC
27834-7503
US

IV. Provider business mailing address

604 MEDICAL DR
GREENVILLE NC
27834-7503
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3939
  • Fax:
Mailing address:
  • Phone: 252-744-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS H BENSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 252-744-7400