Healthcare Provider Details

I. General information

NPI: 1164476834
Provider Name (Legal Business Name): CAROLINAEAST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 FARM LIFE AVE
VANCEBORO NC
28586-7673
US

IV. Provider business mailing address

PO BOX 529
VANCEBORO NC
28586-0529
US

V. Phone/Fax

Practice location:
  • Phone: 252-244-1785
  • Fax:
Mailing address:
  • Phone: 252-244-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberH0201
License Number StateNC

VIII. Authorized Official

Name: MRS. TAMMY M SHERRON
Title or Position: CFO/ VP FINANCE
Credential:
Phone: 252-633-8880