Provider Demographics
NPI:1558304311
Name:EASTERN CAROLINA SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:EASTERN CAROLINA SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-734-1141
Mailing Address - Street 1:2811 MCLAMB PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1647
Mailing Address - Country:US
Mailing Address - Phone:919-734-1141
Mailing Address - Fax:919-734-3509
Practice Address - Street 1:2811 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1647
Practice Address - Country:US
Practice Address - Phone:919-734-1141
Practice Address - Fax:919-734-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890117RMedicaid
NC0117ROtherBCBS OF NC
NC890117RMedicaid