Provider Demographics
NPI:1164476834
Name:CAROLINAEAST MEDICAL CENTER
Entity Type:Organization
Organization Name:CAROLINAEAST MEDICAL CENTER
Other - Org Name:CAROLINAEAST PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-8880
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-0529
Mailing Address - Country:US
Mailing Address - Phone:252-244-1785
Mailing Address - Fax:
Practice Address - Street 1:620 FARM LIFE AVE
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-7673
Practice Address - Country:US
Practice Address - Phone:252-244-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0254HOtherNCBCBS
NC890254HMedicaid
NC=========-015OtherTRICARE
NC=========OtherCOMMERCIAL
NC=========-015OtherTRICARE