Provider Demographics
NPI:1669423364
Name:EASTERN CAROLINA FAMILY MEDICINE
Entity type:Organization
Organization Name:EASTERN CAROLINA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-665-2600
Mailing Address - Street 1:PO BOX 5357
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5357
Mailing Address - Country:US
Mailing Address - Phone:843-665-2600
Mailing Address - Fax:843-665-7530
Practice Address - Street 1:3124 S CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6302
Practice Address - Country:US
Practice Address - Phone:843-665-2600
Practice Address - Fax:843-665-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7525Medicare UPIN
SC6418030001Medicare NSC