Organization
EASTERN NORTH CAROLINA MEDICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE H BAILEY (MANAGER)
(252) 451-2700
Entity
Organization
Contact information
Practice address
1812 GLENDALE DR SW, SUITE B, WILSON, NC 27893-4676
(252) 291-3100
(252) 243-0599
Mailing address
PO BOX 7867, ROCKY MOUNT, NC 27804-0867
(252) 451-2700
(252) 243-0599
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RH0000X
Hematology (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011C5
BCBS GROUP ID#
NC
05
—
89011C5
—
NC
Enumeration date
12/22/2009
Last updated
04/04/2012
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