Provider Demographics
NPI:1003894304
Name:EAST CAROLINA HEALTH-BERTIE
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH-BERTIE
Other - Org Name:BERTIE MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-6000
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0040
Mailing Address - Country:US
Mailing Address - Phone:252-794-6600
Mailing Address - Fax:
Practice Address - Street 1:1403 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9666
Practice Address - Country:US
Practice Address - Phone:252-794-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH-BERTIE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-06
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000331Medicaid
NC0003AOtherBCBS CRNA GROUP #