Provider Demographics
NPI:1952343022
Name:EAST CAROLINA HEALTH
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH
Other - Org Name:ROANOKE CHOWAN UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-3610
Mailing Address - Street 1:312 ACADEMY ST S STE A
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3200
Mailing Address - Country:US
Mailing Address - Phone:252-332-6444
Mailing Address - Fax:252-332-5417
Practice Address - Street 1:312 ACADEMY ST S STE A
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3200
Practice Address - Country:US
Practice Address - Phone:252-332-6444
Practice Address - Fax:252-332-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903831Medicaid
NC018H1OtherBCBS GROUP ID
NCCH9789OtherRR MEDICARE
NC2351755VMedicare PIN