Provider Demographics
NPI:1508883455
Name:EAST COAST MEDICAL
Entity Type:Organization
Organization Name:EAST COAST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-838-8848
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:HARKERS ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28531
Mailing Address - Country:US
Mailing Address - Phone:252-838-8848
Mailing Address - Fax:252-838-8849
Practice Address - Street 1:112B STRAITS RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-838-8848
Practice Address - Fax:252-838-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045KTOtherBCBSNC
NC7703064Medicaid
1284380001Medicare ID - Type Unspecified