1275626921 NPI number — ELIZABETH CITY ORTHOPEDIC SURGERY CENTER

Table of content: (NPI 1275626921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275626921 NPI number — ELIZABETH CITY ORTHOPEDIC SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH CITY ORTHOPEDIC SURGERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275626921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1134 NORTH ROAD STREET
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-338-3993
Provider Business Mailing Address Fax Number:
252-338-2829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1134 NORTH ROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-3993
Provider Business Practice Location Address Fax Number:
252-338-2829
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
252-338-3993

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 134PE . This is a "BCBS NC DR. KONA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1245206820 . This is a "NPI DR. KONA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 142PX . This is a "BCBS NC DR. THORP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89134PE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376589374 . This is a "NPI DR. THORP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: POOO26558 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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