Provider Demographics
NPI:1831201854
Name:KINSTON ORTHOPAEDIC & SPORTS MEDICINE CENTER, P.A.
Entity type:Organization
Organization Name:KINSTON ORTHOPAEDIC & SPORTS MEDICINE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-522-2020
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1584
Mailing Address - Country:US
Mailing Address - Phone:252-522-2020
Mailing Address - Fax:252-527-7133
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE G
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-522-2020
Practice Address - Fax:252-527-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39225207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901978Medicaid
NC01978OtherBCBS PROVIDER NUMBER
NC0468350001OtherMEDICARE DME
NCCJ2328OtherMEDICARE RAILROAD
NC230172Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER