Provider Demographics
NPI:1295033751
Name:PREMIER HEALTH CENTER INTERNAL MEDICINE AND PALLIATIVE CARE SERVICE
Entity Type:Organization
Organization Name:PREMIER HEALTH CENTER INTERNAL MEDICINE AND PALLIATIVE CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:AFAQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-567-9001
Mailing Address - Street 1:708 RUSHING FALLS PLACE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1956
Mailing Address - Country:US
Mailing Address - Phone:919-567-9001
Mailing Address - Fax:919-557-5540
Practice Address - Street 1:409 WAKE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1956
Practice Address - Country:US
Practice Address - Phone:919-567-9001
Practice Address - Fax:919-557-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401463207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138NHMedicaid