Healthcare Provider Details

I. General information

NPI: 1104859313
Provider Name (Legal Business Name): KINSTON COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N QUEEN STREET
KINSTON NC
28501-4932
US

IV. Provider business mailing address

PO BOX 2278
KINSTON NC
28502-2278
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-9800
  • Fax: 252-523-9790
Mailing address:
  • Phone: 252-522-9800
  • Fax: 252-522-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZANNE FREEMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 252-522-9800