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NPI Code Detail

MEDICARE: EASTERN PSYCHIATRIC & BEHAVIORAL SPECIALISTS, PLLC

MEDICARE: EASTERN PSYCHIATRIC & BEHAVIORAL SPECIALISTS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3012MUOTHERNCBCBS GROUP NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
50276LOTHERNCBCBS GROUP NUMBER

General Provider Information

NPI Number : 1558426007
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN PSYCHIATRIC & BEHAVIORAL SPECIALISTS, PLLC
Provider Business Mailing Address
First Line : 1704 E ARLINGTON BLVD STE A
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-7828
Country : US
Telephone Number : 252-756-4899
Fax Number : 252-756-5141
Provider Business Practice Location Address
First Line : 1704 E ARLINGTON BLVD STE A
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-7828
Country : US
Telephone Number : 252-756-4899
Fax Number : 252-756-5141
Authorized Official
Title or Position : ADMINISTRATOR
Name : HEATHER DUNN BAKER
Credential :
Telephone Number : 252-756-4899
Provider Enumeration Date : 12/26/2006
Last Update Date : 02/10/2026

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