Provider Demographics
NPI:1992749220
Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:FARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-667-6710
Mailing Address - Street 1:1530 MCCLURE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6046
Mailing Address - Country:US
Mailing Address - Phone:843-667-6710
Mailing Address - Fax:843-317-9784
Practice Address - Street 1:1530 MCCLURE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6046
Practice Address - Country:US
Practice Address - Phone:843-667-6710
Practice Address - Fax:843-317-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0183Medicaid