Healthcare Provider Details

I. General information

NPI: 1063520070
Provider Name (Legal Business Name): EAST CAROLINA GASTROENTEROLOGY ENDOSCOPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OFFICE PARK DR
JACKSONVILLE NC
28546-7325
US

IV. Provider business mailing address

4 OFFICE PARK DR
JACKSONVILLE NC
28546-7325
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-6158
  • Fax: 910-353-7257
Mailing address:
  • Phone: 910-353-6158
  • Fax: 910-353-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER A EWEJE
Title or Position: PRESIDENT
Credential: MD
Phone: 910-353-6158