Provider Demographics
NPI:1336101369
Name:HEATHEAST OUTER BANKS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:HEATHEAST OUTER BANKS MEDICAL CENTER LLC
Other - Org Name:HEALTHEAST FAMILY CARE-HATTERAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE FOR EAST CAROLINA HEA
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-847-7479
Mailing Address - Street 1:57635 HWY 12
Mailing Address - Street 2:
Mailing Address - City:HATTERAS
Mailing Address - State:NC
Mailing Address - Zip Code:27943
Mailing Address - Country:US
Mailing Address - Phone:252-986-2756
Mailing Address - Fax:
Practice Address - Street 1:57635 HWY 12
Practice Address - Street 2:
Practice Address - City:HATTERAS
Practice Address - State:NC
Practice Address - Zip Code:27943
Practice Address - Country:US
Practice Address - Phone:252-986-2756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0290UOtherBCBS #
NC790155CMedicaid
NC0290UOtherBCBS #
NCDA5754Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
NC2325712AMedicare ID - Type UnspecifiedMEDICARE PROV. #