Provider Demographics
NPI:1548625684
Name:ALI LUNG CLINIC PC
Entity type:Organization
Organization Name:ALI LUNG CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:MUSTAFA
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-205-1627
Mailing Address - Street 1:706 WILKINS ST
Mailing Address - Street 2:STE C
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4662
Mailing Address - Country:US
Mailing Address - Phone:919-205-1627
Mailing Address - Fax:919-205-1686
Practice Address - Street 1:706 WILKINS ST
Practice Address - Street 2:STE C
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4662
Practice Address - Country:US
Practice Address - Phone:919-205-1627
Practice Address - Fax:919-205-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01985261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center