Provider Demographics
NPI:1619955705
Name:EAST CAROLINA HEALTH-BERTIE
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH-BERTIE
Other - Org Name:PROFESSIONAL ED BILLING BERTIE MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-6600
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:252-794-6685
Mailing Address - Fax:252-794-6771
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:252-794-6685
Practice Address - Fax:252-794-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0268207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020VPOtherBCBS
NC5950582Medicaid
NC020VPOtherBCBS