Provider Demographics
NPI:1417919689
Name:ROANOKE CHOWAN SURGERY CENTER
Entity Type:Organization
Organization Name:ROANOKE CHOWAN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-332-6360
Mailing Address - Street 1:312 ACADEMY ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3200
Mailing Address - Country:US
Mailing Address - Phone:252-332-6360
Mailing Address - Fax:252-332-8135
Practice Address - Street 1:312 ACADEMY ST S
Practice Address - Street 2:SUITE A
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3200
Practice Address - Country:US
Practice Address - Phone:252-332-6360
Practice Address - Fax:252-332-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0260COtherBCBS
NC890260CMedicaid
NC890260CMedicaid
NC0260COtherBCBS