Provider Demographics
NPI:1386620060
Name:HEALTHEAST FAMILY CARE OF NAGS HEAD
Entity type:Organization
Organization Name:HEALTHEAST FAMILY CARE OF NAGS HEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:GETRUDE
Authorized Official - Last Name:LEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-441-3177
Mailing Address - Street 1:4810 S CROATAN HIGHWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959
Mailing Address - Country:US
Mailing Address - Phone:252-441-3177
Mailing Address - Fax:252-441-2271
Practice Address - Street 1:4810 S CROATAN HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959
Practice Address - Country:US
Practice Address - Phone:252-441-3177
Practice Address - Fax:252-441-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890314EMedicaid
NC0314EOtherBCBS OF NC
NC0314EOtherBCBS OF NC