1881675247 NPI number — ALPHA MEDICAL AIDS, INC.

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

Provider Other Organization Name	:	ALPHA MEDICAL CONTIN-U-CARE
Provider Other Organization Name Type Code	:	5
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	:	1881675247
Entity Type Code	:	Organization
Replacement NPI	:
Last Update Date	:	06/02/2010
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	516 PANTOPS CTR
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	CHARLOTTESVILLE
Provider Business Mailing Address State Name	:	VA
Provider Business Mailing Address Postal Code	:	229118665
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	4349717300
Provider Business Mailing Address Fax Number	:	4349713739

Provider First Line Business Practice Location Address	:	516 PANTOPS CTR
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	CHARLOTTESVILLE
Provider Business Practice Location Address State Name	:	VA
Provider Business Practice Location Address Postal Code	:	229118665
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	4349717300
Provider Business Practice Location Address Fax Number	:	4349713739
Provider Enumeration Date	:	11/10/2005

Authorized Official Last Name	:	DEATON
Authorized Official First Name	:	EBBEN
Authorized Official Middle Name	:	C.
Authorized Official Title or Position	:	PRESIDENT/ OWNER
Authorized Official Telephone Number	:	4349717300

• Taxonomy code: 332B00000X .

• Identifier: 009132597 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 123764 . This is a "SOUTHERN HEALTH PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 0206450001 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 224574 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 009133054 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 051686 . This is a "ANTHEM BCBS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 322965 . This is a "ANTHEM BCBS MEDIGAP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "".