=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093772600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS EAST, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 04/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 MCCRAE STREET
-----------------------------------------------------
City | GRIFTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-524-5463
-----------------------------------------------------
Fax | 252-524-0681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 W ARLINGTON BLVD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-752-6101
-----------------------------------------------------
Fax | 252-752-6600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MRS. CINDY MCGEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-752-6101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | NC AP 0000 1014
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------