Healthcare Provider Details

I. General information

NPI: 1558312934
Provider Name (Legal Business Name): EAST CAROLINA UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ECU, BELK ANNEX 5 DEPT. OF COMMUNICATION SCIENCES & DISORDERS
GREENVILLE NC
27858
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3253
  • Fax:
Mailing address:
  • Phone: 252-744-3253
  • Fax: 252-744-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS BENSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 252-744-3253