Provider Demographics
NPI:1932323060
Name:AHMED IBN-MAHFOUDH
Entity Type:Organization
Organization Name:AHMED IBN-MAHFOUDH
Other - Org Name:PREMIER HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:IBN-MAHFOUDH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-567-9001
Mailing Address - Street 1:708 RUSHING FALLS PL
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6975
Mailing Address - Country:US
Mailing Address - Phone:919-567-9001
Mailing Address - Fax:919-701-0044
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:919-701-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130NYMedicaid
NC89130NYMedicaid
NCH53725Medicare UPIN