Provider Demographics
NPI:1275626921
Name:ELIZABETH CITY ORTHOPEDIC SURGERY CENTER
Entity Type:Organization
Organization Name:ELIZABETH CITY ORTHOPEDIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-3993
Mailing Address - Street 1:1134 NORTH ROAD STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-338-3993
Mailing Address - Fax:252-338-2829
Practice Address - Street 1:1134 NORTH ROAD STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-338-3993
Practice Address - Fax:252-338-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134PEOtherBCBS NC DR. KONA
NC1245206820OtherNPI DR. KONA
NC142PXOtherBCBS NC DR. THORP
NC89134PEMedicaid
NC1376589374OtherNPI DR. THORP
NCPOOO26558OtherRAILROAD MEDICARE
NC142PXOtherBCBS NC DR. THORP
NCF33194Medicare UPIN
NC1376589374OtherNPI DR. THORP