Provider Demographics
NPI:1396730883
Name:KASSELT BONE AND JOINT CENTER, P.A.
Entity type:Organization
Organization Name:KASSELT BONE AND JOINT CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:R
Authorized Official - Last Name:KASSELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-523-6506
Mailing Address - Street 1:2104 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2222
Mailing Address - Country:US
Mailing Address - Phone:252-523-6506
Mailing Address - Fax:252-523-6969
Practice Address - Street 1:2104 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2222
Practice Address - Country:US
Practice Address - Phone:252-523-6506
Practice Address - Fax:252-523-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35389207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0564940001OtherPALMETTO GBA
NC2324236OtherMEDICARE
NC0292LOtherBLUE CROSS OF NC
NC890292LMedicaid
NC2324236Medicare ID - Type Unspecified
NC0564940001OtherPALMETTO GBA