Provider Demographics
NPI:1528639689
Name:AMM HEALTHCARE, PA
Entity type:Organization
Organization Name:AMM HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-219-8310
Mailing Address - Street 1:PO BOX 986513
Mailing Address - Street 2:DEPT. 200
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8310
Mailing Address - Fax:
Practice Address - Street 1:530 NEW WAVERLY PL STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-650-6066
Practice Address - Fax:919-882-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty