Northeastern Orthopedics, PA
Organization Active NPI Orthopaedic Surgery Physician · Ahoskie, NC
NPI 1821054339 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1821054339
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 88829 (NC)
- Legal business name
- NORTHEASTERN ORTHOPEDICS, PA
- Practice address
- 602 Academy St S
Ahoskie, NC 27910-3239 - Phone
- (252) 332-3699
- Fax
- (252) 332-4335
- NPI assigned
- Apr 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Margaret Stevenson Larabee
- Title
- Secretary, Treasurer
- Phone
- (252) 332-3699
Practitioners 7
-
Kern Lee Barrow, PA
-
Samuel Steven Floyd Jr., PA-C
-
Timothy W Childers, PA-C
-
Penny Shelton, ACNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040213000341 | NC | Part B Supplier - Clinic/Group Practice | 7416841945 |
Receives reassigned benefits from 3 practitioners Practice locations: Ahoskie, NC |
National Provider Directory
Locations
602 Academy St S
Ahoskie, NC 27910
Phone (252) 209-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | 88829 | NC | Yes |
Addresses
Primary practice location
602 Academy St S
Ahoskie, NC 27910-3239
Mailing address
602 Academy St S
Ahoskie, NC 27910-3239
Phone (252) 332-3699
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011MR | Other | NC | BLUE CROSS OF NC GROUP NU |
| 89011MR | Medicaid | NC |
Other providers in Ahoskie, NC
- Elizabeth Caldwell Nelson
- New Beginnings Program
- New Life Community Supports, Inc.
- Katlyn Small Nixon
- Melissa Leggett Northcott
- Nuvizions LLC
- Lynn M. Olsefski
- Oncall Nursing of NC Inc
- Optimum Behavioral Health Care
- Kymond D Outlaw
All providers in Ahoskie, NC · Orthopaedic Surgery Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.