Healthcare Provider Details

I. General information

NPI: 1841540887
Provider Name (Legal Business Name): LENOIR PHYSICIANS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DOCTORS DR SUITE G
KINSTON NC
28501-1589
US

IV. Provider business mailing address

701 DOCTORS DR SUITE G
KINSTON NC
28501-1589
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-4446
  • Fax: 252-522-4484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY E. BLACK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 252-522-7000