Provider Demographics
NPI:1093875239
Name:EASTERN CAROLINA INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:EASTERN CAROLINA INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-1010
Mailing Address - Street 1:2117 SOUTH GLENBURNIE ROAD
Mailing Address - Street 2:STE 9 & 10
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2239
Mailing Address - Country:US
Mailing Address - Phone:252-636-1001
Mailing Address - Fax:252-636-1188
Practice Address - Street 1:2117 SOUTH GLENBURNIE ROAD
Practice Address - Street 2:STE 9 & 10
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2239
Practice Address - Country:US
Practice Address - Phone:252-636-1001
Practice Address - Fax:252-636-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCREGISTRATIONNO39206261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01907OtherBCBS NC
NC7902320Medicaid
NC01907OtherBCBS NC