1720039241 NPI number — EAST CAROLINA UNIVERSITY

Table of content: (NPI 1720039241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720039241 NPI number — EAST CAROLINA UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST CAROLINA UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ECU PHYSICIANS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720039241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-744-3253
Provider Business Mailing Address Fax Number:
252-744-3194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VIQUEST
Provider Second Line Business Practice Location Address:
2610 STANTONSBURG ROAD
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-744-3977
Provider Business Practice Location Address Fax Number:
252-744-6503
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
252-744-7400

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014A9 . This is a "GROUP PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0315 . This is a "BCBS NC GROUP PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89014A9 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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