Provider Demographics
NPI:1215303359
Name:EASTERN HEALTHCARE ASSOCIATES
Entity type:Organization
Organization Name:EASTERN HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-689-6524
Mailing Address - Street 1:2245 STANTONSBURG RD
Mailing Address - Street 2:SUITE 0
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2868
Mailing Address - Country:US
Mailing Address - Phone:252-689-6524
Mailing Address - Fax:252-689-6585
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:SUITE 0
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-689-6524
Practice Address - Fax:252-689-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF194Medicare UPIN