Provider Demographics
NPI:1073690467
Name:EASTERN CAROLINAS IMAGING, LLC
Entity Type:Organization
Organization Name:EASTERN CAROLINAS IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:INETTE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-640-7070
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1595
Mailing Address - Country:US
Mailing Address - Phone:910-640-2823
Mailing Address - Fax:910-640-3327
Practice Address - Street 1:109 N JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3123
Practice Address - Country:US
Practice Address - Phone:910-640-2823
Practice Address - Fax:910-640-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700465261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890213JMedicaid
NC2881824Medicare ID - Type Unspecified
NC890213JMedicaid