Provider Demographics
NPI:1306046875
Name:VANCEBORO INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:VANCEBORO INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:252-672-7730
Mailing Address - Street 1:260 NC HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-8906
Mailing Address - Country:US
Mailing Address - Phone:252-244-4700
Mailing Address - Fax:252-244-4702
Practice Address - Street 1:260 NC HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-8906
Practice Address - Country:US
Practice Address - Phone:252-244-4700
Practice Address - Fax:252-244-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1106LOtherNORTH CAROLINA BCBS
NC891106LMedicaid
NC1106LOtherNORTH CAROLINA BCBS