Basic Information
| Provider Information | |||||||||
| NPI: | 1386609980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS EAST, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4796 OLD TAR RD | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285909752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523534111 | ||||||||
| FaxNumber: | 2523531727 | ||||||||
| Practice Location | |||||||||
| Address1: | 4796 OLD TAR RD | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285909752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523534111 | ||||||||
| FaxNumber: | 2523531727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCGEE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2527526101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | AP 00000582 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890290M | 05 | NC | MEDICAID |