Basic Information
| Provider Information | |||||||||
| NPI: | 1558304311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN CAROLINA SURGICAL ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 MCLAMB PL | ||||||||
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| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275341647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197341141 | ||||||||
| FaxNumber: | 9197343509 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 MCLAMB PL | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275341647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197341141 | ||||||||
| FaxNumber: | 9197343509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9197341141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 208600000X | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 890117R | 05 | NC | MEDICAID | 0117R | 01 | NC | BCBS OF NC | OTHER |