Provider Demographics
NPI:1578541660
Name:EAST CAROLINA HEALTH-BERTIE
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH-BERTIE
Other - Org Name:ECU HEALTH FAMILY MEDICINE-WINDSOR, A DEPARTMENT OF ECU HEALTH BERTIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-482-6268
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0509
Mailing Address - Country:US
Mailing Address - Phone:252-794-3101
Mailing Address - Fax:
Practice Address - Street 1:1403 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9666
Practice Address - Country:US
Practice Address - Phone:252-794-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0314FOtherBCBS PROVIDER #
NC344623AMedicaid
NC344623CMedicaid
NC344623CMedicaid
NC2325592AMedicare Oscar/Certification