Provider Demographics
NPI:1336102144
Name:EAST CAROLINA HEALTH - CHOWAN INC
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH - CHOWAN INC
Other - Org Name:CHOWAN OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-482-6268
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0569
Mailing Address - Country:US
Mailing Address - Phone:252-482-2134
Mailing Address - Fax:252-482-5529
Practice Address - Street 1:203 EARNHARDT DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8401
Practice Address - Country:US
Practice Address - Phone:252-482-2134
Practice Address - Fax:252-482-5529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH - CHOWAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200358261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902688Medicaid
NC018A6OtherBCBS PROVIDER #
NC5902688Medicaid