Provider Demographics
NPI:1649229667
Name:EAST CAROLINA UNIVERSITY
Entity Type:Organization
Organization Name:EAST CAROLINA UNIVERSITY
Other - Org Name:ECU PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-744-7400
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:110 RAILROAD STREET
Practice Address - Street 2:BETHEL FAMILY MEDICINE CENTER
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812
Practice Address - Country:US
Practice Address - Phone:252-825-0355
Practice Address - Fax:252-825-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8907017Medicaid
NC03015OtherBCBS NC GROUP PROVIDER #
NC8903015Medicaid
NC0280Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER