Provider Demographics
NPI:1578303855
Name:AL-AQSA COMMUNITY CLINIC
Entity type:Organization
Organization Name:AL-AQSA COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-350-1642
Mailing Address - Street 1:1908 S MEBANE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6322
Mailing Address - Country:US
Mailing Address - Phone:336-350-1642
Mailing Address - Fax:336-395-8370
Practice Address - Street 1:1908 S MEBANE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6322
Practice Address - Country:US
Practice Address - Phone:336-350-1642
Practice Address - Fax:336-395-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty