Provider Demographics
NPI:1538235494
Name:EASTERN CAROLINA PAIN MANAGEMENT CENTER INC
Entity type:Organization
Organization Name:EASTERN CAROLINA PAIN MANAGEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-251-8474
Mailing Address - Street 1:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0426
Mailing Address - Country:US
Mailing Address - Phone:910-251-8474
Mailing Address - Fax:910-251-2202
Practice Address - Street 1:2035 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-323-8454
Practice Address - Fax:910-321-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35361208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939989Medicaid
NC39989OtherBLUE CROSS
NC8939989Medicaid
NC2204794Medicare ID - Type Unspecified