Provider Demographics
NPI:1093772600
Name:PHYSICIANS EAST, PA
Entity Type:Organization
Organization Name:PHYSICIANS EAST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-6101
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-752-6101
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:416 MCCRAE STREET
Practice Address - Street 2:
Practice Address - City:GRIFTON
Practice Address - State:NC
Practice Address - Zip Code:28530
Practice Address - Country:US
Practice Address - Phone:252-524-5463
Practice Address - Fax:252-524-0681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS EAST, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC AP 0000 1014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890293UMedicaid
2320056Medicare ID - Type Unspecified