Provider Demographics
NPI:1275857294
Name:EASTERN PHYSICAL MEDICINE & REHABILITATION, LLC
Entity Type:Organization
Organization Name:EASTERN PHYSICAL MEDICINE & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-215-9294
Mailing Address - Street 1:2245 STANTONSBURG RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2868
Mailing Address - Country:US
Mailing Address - Phone:252-215-9294
Mailing Address - Fax:252-215-9279
Practice Address - Street 1:2245 STANTONSBURG RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-215-9294
Practice Address - Fax:252-215-9279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200604208100000X
NC208100000X
208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136YXMedicaid
NC2026850CMedicare PIN
NC89136YXMedicaid