Provider Demographics
NPI:1902841638
Name:Q.A. THAI NEUROSURGERY CENTER PC
Entity Type:Organization
Organization Name:Q.A. THAI NEUROSURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:QUOC-ANH
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-331-2242
Mailing Address - Street 1:105 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4345
Mailing Address - Country:US
Mailing Address - Phone:252-331-2242
Mailing Address - Fax:252-331-2929
Practice Address - Street 1:105 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4345
Practice Address - Country:US
Practice Address - Phone:252-331-2242
Practice Address - Fax:252-331-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00270207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905230Medicaid
NC2324290Medicare ID - Type Unspecified
NCI30891Medicare UPIN