Provider Demographics
NPI:1710185574
Name:EASTERN CAROLINA FAMILY PRACTICE
Entity Type:Organization
Organization Name:EASTERN CAROLINA FAMILY PRACTICE
Other - Org Name:EASTERN CAROLINA FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-331-1100
Mailing Address - Street 1:105 COMMERCE STREET
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:POWELLSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27967
Mailing Address - Country:US
Mailing Address - Phone:252-332-6484
Mailing Address - Fax:252-332-1660
Practice Address - Street 1:105 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:POWELLSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27967
Practice Address - Country:US
Practice Address - Phone:252-332-6484
Practice Address - Fax:252-332-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36700261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC348939Medicare ID - Type Unspecified