Provider Demographics
NPI:1437246204
Name:PAMLICO REGIONAL MEDICAL CENTER PA
Entity Type:Organization
Organization Name:PAMLICO REGIONAL MEDICAL CENTER PA
Other - Org Name:ORIENTAL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNN JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-745-3191
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-0729
Mailing Address - Country:US
Mailing Address - Phone:252-745-3191
Mailing Address - Fax:252-745-7385
Practice Address - Street 1:606 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515
Practice Address - Country:US
Practice Address - Phone:252-745-3191
Practice Address - Fax:252-745-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902364Medicaid
NC02364OtherBLUE CROSS BLUE SHIELD
NC02364OtherBLUE CROSS BLUE SHIELD
NC2309835AMedicare ID - Type UnspecifiedORIENTAL MEDICAL CENTER
NC0681130001Medicare NSC
NC2309835Medicare PIN