Provider Demographics
NPI:1386972750
Name:KINSTON MEDICAL SPECIALISTS PA
Entity type:Organization
Organization Name:KINSTON MEDICAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-559-2200
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:252-559-2200
Mailing Address - Fax:252-523-7642
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE N
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:252-559-2200
Practice Address - Fax:252-523-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical