Provider Demographics
NPI:1508044918
Name:DUPLIN SURGICAL, PA
Entity Type:Organization
Organization Name:DUPLIN SURGICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DYREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-275-0027
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0490
Mailing Address - Country:US
Mailing Address - Phone:910-275-0027
Mailing Address - Fax:910-296-0214
Practice Address - Street 1:417 N MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-275-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900856Medicaid
1334XOtherBCBS OF NORTH CAROLINA
2346805Medicare PIN