Provider Demographics
NPI:1043275332
Name:EASTERN CARTERET MEDICAL CENTER
Entity Type:Organization
Organization Name:EASTERN CARTERET MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-225-1134
Mailing Address - Street 1:458 HIGHWAY 70 EAST
Mailing Address - Street 2:
Mailing Address - City:SEA LEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:28577
Mailing Address - Country:US
Mailing Address - Phone:252-225-1134
Mailing Address - Fax:252-225-1165
Practice Address - Street 1:458 HIGHWAY 70 EAST
Practice Address - Street 2:
Practice Address - City:SEA LEVEL
Practice Address - State:NC
Practice Address - Zip Code:28577-0130
Practice Address - Country:US
Practice Address - Phone:252-225-1134
Practice Address - Fax:252-225-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0275JOtherBLUE CROSS BLUE SHIELD
NC8907640Medicaid
NC8907640Medicaid
NC0275JOtherBLUE CROSS BLUE SHIELD