Provider Demographics
NPI:1174585012
Name:HEALTHEAST OUTER BANKS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:HEALTHEAST OUTER BANKS MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE FOR EAST CAROLINA HEA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-847-7479
Mailing Address - Street 1:40894 HWY 12
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NC
Mailing Address - Zip Code:27915
Mailing Address - Country:US
Mailing Address - Phone:252-995-3073
Mailing Address - Fax:
Practice Address - Street 1:40894 HWY 12
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NC
Practice Address - Zip Code:27915
Practice Address - Country:US
Practice Address - Phone:252-995-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0290ROtherBCBS PROVIDER #
NC790290RMedicaid
NC790290RMedicaid
NC790290RMedicaid
NCDB4122Medicare ID - Type UnspecifiedRAILROAD MEDICARE #