Provider Demographics
NPI:1821076589
Name:EAST CAROLINA HEALTH - HERITAGE INC
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH - HERITAGE INC
Other - Org Name:VIDANT FAMILY MEDICINE-PINETOPS A DEPARTMENT OF VIDANT EDGECOMBE HOSPI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-641-7131
Mailing Address - Street 1:1473 NC 42-43 WEST
Mailing Address - Street 2:
Mailing Address - City:PINETOPS
Mailing Address - State:NC
Mailing Address - Zip Code:27864-7188
Mailing Address - Country:US
Mailing Address - Phone:252-827-5231
Mailing Address - Fax:252-827-5775
Practice Address - Street 1:1473 NC 42-43 WEST
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27864-7188
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:252-827-5775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH - HERITAGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0258261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344625CMedicaid
NC344625AMedicaid
NC0164QOtherBCBS PROVIDER #
NC344625AMedicaid