Provider Demographics
NPI:1588678916
Name:AHMED ABOUL-MAGD PC
Entity Type:Organization
Organization Name:AHMED ABOUL-MAGD PC
Other - Org Name:JOPLIN NEPHROLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:SAMEH
Authorized Official - Last Name:ABOUL-MAGD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-782-5000
Mailing Address - Street 1:522 W 32ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2533
Mailing Address - Country:US
Mailing Address - Phone:417-782-5000
Mailing Address - Fax:
Practice Address - Street 1:522 W 32ND ST STE 1
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2533
Practice Address - Country:US
Practice Address - Phone:417-782-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000111075OtherBLUE CROSS BLUE SHIELD
MO506197508Medicaid
KS200303400AMedicaid
OK200049590AMedicaid
DC4777OtherRAILROAD MEDICARE
DC4777OtherRAILROAD MEDICARE
KS0000111075OtherBLUE CROSS BLUE SHIELD
MO000014325Medicare ID - Type Unspecified