Provider Demographics
NPI:1497848048
Name:EAST CAROLINA NEUROLOGY, INC.
Entity Type:Organization
Organization Name:EAST CAROLINA NEUROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THATCHER
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:252-752-4848
Mailing Address - Street 1:2280 HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3773
Mailing Address - Country:US
Mailing Address - Phone:252-752-4848
Mailing Address - Fax:252-752-9607
Practice Address - Street 1:2280 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3773
Practice Address - Country:US
Practice Address - Phone:252-752-4848
Practice Address - Fax:252-752-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2646103G00000X
NC1188103TC0700X
207ZN0500X, 2084N0400X, 2084N0402X, 2084N0600X, 2084S0012X, 2084V0102X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01478OtherBLUE CROSS BLUE SHIELD
NC6005989OtherMEDICAID MENTAL HEALTH
NC8901478Medicaid
NC6005989OtherMEDICAID MENTAL HEALTH
NC8901478Medicaid