Eastern Carolina Internal Medicine PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

REGISTRATIONNO39206 Issued in NC

Legal business name

EASTERN CAROLINA INTERNAL MEDICINE PA

Practice address

532 Webb Blvd
Havelock, NC 28532-2042

Phone

(252) 447-7088

Fax

(252) 447-2752

NPI assigned

Nov 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Craig A Holton

Title

Chief Operating Officer

Phone

(252) 633-1010

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Matthew Smith, MD

  • Internal Medicine Physician
  • New Bern, NC
  • NPI 1932192713
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346329117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 WEBB BLVD",
            "city": "HAVELOCK",
            "state": "NC",
            "postal_code": "285322042",
            "telephone_number": "252-447-7088",
            "fax_number": "252-447-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "532 WEBB BLVD",
            "city": "HAVELOCK",
            "state": "NC",
            "postal_code": "285322042",
            "telephone_number": "252-447-7088",
            "fax_number": "252-447-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN CAROLINA INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLTON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "252-633-1010"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": "REGISTRATIONNO39206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890231Q",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "01907",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cynthia Ellis
• David Jeffrey Ellis, LPC

• Multi-Specialty Clinic/Center in Havelock, NC
• Providers in Havelock, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.