Provider Demographics
NPI:1265909980
Name:KINSTON REGIONAL PAIN CENTER LLC
Entity type:Organization
Organization Name:KINSTON REGIONAL PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-208-7784
Mailing Address - Street 1:2100 PRESBYTERIAN LN
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 PRESBYTERIAN LN
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2266
Practice Address - Country:US
Practice Address - Phone:814-720-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty