Basic Information
| Provider Information | |||||||||
| NPI: | 1437108719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS EAST, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREENVILLE OB/GYN | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 W ARLINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527526101 | ||||||||
| FaxNumber: | 2527526600 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 BETHESDA DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278347201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527584181 | ||||||||
| FaxNumber: | 2527522603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCGEE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2527526101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHYSICIANS EAST, P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | NC AP 00000630 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 890290V | 05 | NC | MEDICAID |