Provider Demographics
NPI:1588914527
Name:LENOIR PHYSICIANS NETWORK, LLC
Entity type:Organization
Organization Name:LENOIR PHYSICIANS NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-522-7000
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:252-775-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LENOIR PHYSICIANS NETWORK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-18
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588914527Medicaid
NC1588914527Medicaid