Provider Demographics
NPI:1033115407
Name:PHYSICIANS EAST PA
Entity Type:Organization
Organization Name:PHYSICIANS EAST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HALE
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-758-4181
Mailing Address - Street 1:3681 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1464
Mailing Address - Country:US
Mailing Address - Phone:252-753-7141
Mailing Address - Fax:252-753-5834
Practice Address - Street 1:3681 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1464
Practice Address - Country:US
Practice Address - Phone:252-753-7141
Practice Address - Fax:252-753-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890290TMedicaid
NC890290TMedicaid