Provider Demographics
NPI:1467466276
Name:EASTCOAST DIAGNOSTICS & SLEEP CENTERS, INC.
Entity Type:Organization
Organization Name:EASTCOAST DIAGNOSTICS & SLEEP CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:CROMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-860-8378
Mailing Address - Street 1:PO BOX 10487
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0487
Mailing Address - Country:US
Mailing Address - Phone:910-200-9932
Mailing Address - Fax:910-686-8693
Practice Address - Street 1:1830 OWEN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1611
Practice Address - Country:US
Practice Address - Phone:910-860-8378
Practice Address - Fax:910-860-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014H2Medicaid
NC2881808OtherMEDICARE P TAN NUMBER