Provider Demographics
NPI:1124211669
Name:IDEAL HEALTH CARE PLLC
Entity Type:Organization
Organization Name:IDEAL HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-670-2048
Mailing Address - Street 1:200 CASTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7384
Mailing Address - Country:US
Mailing Address - Phone:252-670-2048
Mailing Address - Fax:252-633-1809
Practice Address - Street 1:200 CASTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7384
Practice Address - Country:US
Practice Address - Phone:252-670-2048
Practice Address - Fax:252-633-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF64763Medicare UPIN