Provider Demographics
NPI:1609011147
Name:EAST CAROLINA HEALTH
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH
Other - Org Name:VIDANT ROANOKE CHOWAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-3610
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-3690
Mailing Address - Fax:252-209-3691
Practice Address - Street 1:608 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3239
Practice Address - Country:US
Practice Address - Phone:252-209-3690
Practice Address - Fax:252-209-3691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-12
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950665Medicaid
NC021A3OtherBCBS
NC5950665Medicaid