Provider Demographics
NPI:1558846261
Name:THE CARSON BLACK LUNG RESEARCH AND EDUCATION CENTER
Entity Type:Organization
Organization Name:THE CARSON BLACK LUNG RESEARCH AND EDUCATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-452-6075
Mailing Address - Street 1:850 RIVERVIEW AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1452
Mailing Address - Country:US
Mailing Address - Phone:252-452-4080
Mailing Address - Fax:276-318-0298
Practice Address - Street 1:40518 W MORGAN AVE
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-1822
Practice Address - Country:US
Practice Address - Phone:252-452-6075
Practice Address - Fax:276-318-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center