Healthcare Provider Details

I. General information

NPI: 1669503504
Provider Name (Legal Business Name): THORASIC AND VASCULAR ASSOCIATES OF KINSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 N QUEEN ST
KINSTON NC
28501-1631
US

IV. Provider business mailing address

2508 N QUEEN ST
KINSTON NC
28501-1631
US

V. Phone/Fax

Practice location:
  • Phone: 252-939-9300
  • Fax:
Mailing address:
  • Phone: 252-939-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ART BANE
Title or Position: PRESIDENT
Credential:
Phone: 252-695-6380