Provider Demographics
NPI:1912096843
Name:EAST CAROLINA NEUROLOGY, INC.
Entity Type:Organization
Organization Name:EAST CAROLINA NEUROLOGY, INC.
Other - Org Name:MRI OF EASTERN CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:252-752-4848
Mailing Address - Street 1:402 BOWMAN GRAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7209
Mailing Address - Country:US
Mailing Address - Phone:252-752-9000
Mailing Address - Fax:252-752-1763
Practice Address - Street 1:402 BOWMAN GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7209
Practice Address - Country:US
Practice Address - Phone:252-752-9000
Practice Address - Fax:252-752-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0169ROtherBLUE CROSS BLUE SHIELD
NC890169RMedicaid
NC2313933Medicare ID - Type Unspecified