Provider Demographics
NPI:1801966395
Name:KINSTON HEAD AND NECK PHYSICIANS AND SURGEONS, P.A.
Entity type:Organization
Organization Name:KINSTON HEAD AND NECK PHYSICIANS AND SURGEONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-0687
Mailing Address - Street 1:701 DOCTORS DRIVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1584
Mailing Address - Country:US
Mailing Address - Phone:252-523-0687
Mailing Address - Fax:252-523-0255
Practice Address - Street 1:701 DOCTORS DR STE K
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-523-0687
Practice Address - Fax:252-523-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901959Medicaid
NC8901959Medicaid