Provider Demographics
NPI:1174858773
Name:EASTERN INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:EASTERN INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-991-2067
Mailing Address - Street 1:2635 TILGHMAN RD N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8904
Mailing Address - Country:US
Mailing Address - Phone:252-991-2067
Mailing Address - Fax:252-991-2068
Practice Address - Street 1:2635 TILGHMAN RD N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8904
Practice Address - Country:US
Practice Address - Phone:252-991-2067
Practice Address - Fax:252-991-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2402914BMedicare PIN