1265484992 NPI number — ALPHA MEDICAL AIDS, INC.

Table of content: SERENA MARAIS PERKINS OTR (NPI 1528760469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265484992 NPI number — ALPHA MEDICAL AIDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA MEDICAL AIDS, 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:
6
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:
1265484992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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:
22911-8665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-971-7300
Provider Business Mailing Address Fax Number:
434-971-3739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1548 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISHERSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22939-2242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-942-5300
Provider Business Practice Location Address Fax Number:
540-942-5304
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEATON
Authorized Official First Name:
EBBEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
434-971-7300

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051686 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 322965 . This is a "ANTHEM MEDIGAP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 123765 . This is a "SOUTHERN HEALTH PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 224574 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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