Organization Active NPI

Eastern North Carolina Medical Group, PLLC

  • Internal Medicine Physician
  • Rocky Mount, NC
National Provider Identifier
1154599850
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EASTERN NORTH CAROLINA MEDICAL GROUP, PLLC
Practice address
3400 N Wesleyan Blvd
Rocky Mount, NC 27804-8699
Phone
(252) 985-5187
Fax
(252) 451-2702
NPI assigned
Feb 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Denise H Bailey
Title
Manager
Phone
(252) 451-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3400 N Wesleyan Blvd
Rocky Mount, NC 27804-8699

Mailing address

PO Box 7867
Rocky Mount, NC 27804-0867
Phone (252) 451-2700

Other identifiers 1

IdentifierTypeStateIssuer
89011C5MedicaidNC

National Provider Directory

National Provider Directory

Locations

3400 N Wesleyan Blvd
Rocky Mount, NC 27804
Phone (252) 985-5187

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1154599850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7867",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278040867",
            "telephone_number": "252-451-2700",
            "fax_number": "252-451-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 N WESLEYAN BLVD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278048699",
            "telephone_number": "252-985-5187",
            "fax_number": "252-451-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN NORTH CAROLINA MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "252-451-2700"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011C5",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.