Provider Demographics
NPI:1841248358
Name:EAST CAROLINA UNIVERSITY
Entity type:Organization
Organization Name:EAST CAROLINA UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-744-1882
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:
Mailing Address - Fax:
Practice Address - Street 1:1204 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4196
Practice Address - Country:US
Practice Address - Phone:252-744-1122
Practice Address - Fax:252-744-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0214EOtherBCBS NC GROUP PROVIDER #
NC790214EMedicaid
NC0280Medicare PIN
NC0214EOtherBCBS NC GROUP PROVIDER #