Healthcare Provider Details

I. General information

NPI: 1710185574
Provider Name (Legal Business Name): EASTERN CAROLINA FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCE STREET
POWELLSVILLE NC
27967
US

IV. Provider business mailing address

105 COMMERCE STREET PO BOX 40
POWELLSVILLE NC
27967
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-6484
  • Fax: 252-332-1660
Mailing address:
  • Phone: 252-332-6484
  • Fax: 252-332-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number36700
License Number StateNC

VIII. Authorized Official

Name: DR. LINDSEY L WHITE
Title or Position: OWNER
Credential: MD
Phone: 252-331-1100