1558753277 NPI number — ALPHA MEDICAL INC

Table of content: (NPI 1558753277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558753277 NPI number — ALPHA MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA MEDICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558753277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E 8TH ST
Provider Second Line Business Mailing Address:
SUITE 214-953
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57103-7011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-453-3799
Provider Business Mailing Address Fax Number:
702-453-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORLAND
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82401-3531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-453-3799
Provider Business Practice Location Address Fax Number:
702-453-5741
Provider Enumeration Date:
03/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MARSHALL
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
605-695-1541

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9500A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)