Provider Demographics
NPI:1285080440
Name:CARE2UMEDICAL
Entity type:Organization
Organization Name:CARE2UMEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:252-514-6594
Mailing Address - Street 1:1230 HWY 70 EAST SUITE 1
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-6616
Mailing Address - Country:US
Mailing Address - Phone:252-514-6594
Mailing Address - Fax:252-639-2005
Practice Address - Street 1:1230 US HIGHWAY 70 E STE 1
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6616
Practice Address - Country:US
Practice Address - Phone:252-514-6594
Practice Address - Fax:252-639-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004372Medicaid
NCQ77484Medicare UPIN
NC2592810Medicare PIN