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General NPI Number Information
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NPI Number | 1740384239
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Entity Type | Organization
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Legal Business Name | EAST CAROLINA HEALTH
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 700 ACADEMY ST S
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City | AHOSKIE
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State | NC
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Zip | 27910-3264
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Country | US
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Telephone | 252-209-5404
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Fax | 252-209-5405
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Provider Business Mailing Address
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Address Line | PO BOX 1385
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City | AHOSKIE
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State | NC
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Zip | 27910-1385
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Country | US
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Telephone | 252-209-5404
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Fax | 252-209-5405
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Authorized Official
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Title or Position | C.F.O.
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Name | MR. JON GRAHAM
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Credential |
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Telephone | 252-209-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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