Provider Demographics
NPI:1578533261
Name:THORACIC & VASCULAR ASSOCIATES OF KINSTON PA
Entity Type:Organization
Organization Name:THORACIC & VASCULAR ASSOCIATES OF KINSTON 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:252-939-9300
Mailing Address - Street 1:PO BOX 5485
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-5485
Mailing Address - Country:US
Mailing Address - Phone:252-939-9300
Mailing Address - Fax:252-939-9305
Practice Address - Street 1:204 AIRPORT ROAD
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:252-939-9300
Practice Address - Fax:252-939-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012VXMedicaid
NC012VXOtherBCBS GROUP
NC012VXOtherBCBS GROUP
NC2307974Medicare PIN