Provider Demographics
NPI:1700864980
Name:EAST CAROLINA HEALTH - CHOWAN INC
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH - CHOWAN INC
Other - Org Name:VIDANT CHOWAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARLITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-482-6175
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0629
Mailing Address - Country:US
Mailing Address - Phone:252-482-8451
Mailing Address - Fax:252-482-6274
Practice Address - Street 1:211 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9668
Practice Address - Country:US
Practice Address - Phone:252-482-8451
Practice Address - Fax:252-482-6274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH - CHOWAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-06
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000183Medicaid
NC2618249Medicare ID - Type UnspecifiedCRNA GROUP #