Provider Demographics
NPI:1457436917
Name:FAMILY MEDICINE & REHABILITATION CENTER, PC
Entity type:Organization
Organization Name:FAMILY MEDICINE & REHABILITATION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAQSOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-751-5900
Mailing Address - Street 1:2902 CENTRAL HEIGHTS RD
Mailing Address - Street 2:SUITES A-C
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-6513
Mailing Address - Country:US
Mailing Address - Phone:919-751-5900
Mailing Address - Fax:919-759-1111
Practice Address - Street 1:2902 CENTRAL HEIGHTS RD
Practice Address - Street 2:SUITES A-C
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-6513
Practice Address - Country:US
Practice Address - Phone:919-751-5900
Practice Address - Fax:919-759-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97008372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011NVMedicaid
NC011NVOtherBCBS GROUP ID
NC2344624Medicare ID - Type UnspecifiedGROUP ID
NC011NVOtherBCBS GROUP ID
NC89011NVMedicaid