Provider Demographics
NPI:1407107212
Name:CWCHBO, PA
Entity Type:Organization
Organization Name:CWCHBO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-527-9928
Mailing Address - Street 1:204 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8814
Mailing Address - Country:US
Mailing Address - Phone:252-527-9928
Mailing Address - Fax:252-527-9929
Practice Address - Street 1:204 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8814
Practice Address - Country:US
Practice Address - Phone:252-527-9928
Practice Address - Fax:252-527-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty