Healthcare Provider Details

I. General information

NPI: 1609832369
Provider Name (Legal Business Name): PREECHA BHOTIWIHOK MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT RD
KINSTON NC
28501-1604
US

IV. Provider business mailing address

PO BOX 16068
HIGH POINT NC
27261-6068
US

V. Phone/Fax

Practice location:
  • Phone: 800-277-8151
  • Fax: 336-841-6217
Mailing address:
  • Phone: 888-447-7220
  • Fax: 336-884-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PREECHA BHOTIWIHOK
Title or Position: PRESIDENT
Credential: MD
Phone: 800-277-8151