Provider Demographics
NPI:1538151279
Name:PRIMEVISION KINSTON PA
Entity type:Organization
Organization Name:PRIMEVISION KINSTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-522-1611
Mailing Address - Street 1:2502 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1501
Mailing Address - Country:US
Mailing Address - Phone:252-522-1611
Mailing Address - Fax:252-522-0189
Practice Address - Street 1:2502 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1501
Practice Address - Country:US
Practice Address - Phone:252-522-1611
Practice Address - Fax:252-522-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989526Medicaid
NC8901153Medicaid
NC8928336Medicaid
NC8928336Medicaid
NC2321495Medicare ID - Type UnspecifiedMEDICARE GROUP #
NC=========OtherTAX ID
NC805883BMedicare ID - Type UnspecifiedDR D'S IND PROV #
NC8901153Medicaid
NC8989526Medicaid
NC1153190001Medicare NSC