1316985310 NPI number — ALPHA MEDICAL GROUP,LTD.

Table of content: (NPI 1316985310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316985310 NPI number — ALPHA MEDICAL GROUP,LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA MEDICAL GROUP,LTD.
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:
1316985310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 BUSTLETON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19115-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-676-5100
Provider Business Mailing Address Fax Number:
215-676-4122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-5100
Provider Business Practice Location Address Fax Number:
215-676-4122
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIMBERAKIS
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
215-676-5100

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1008229 . This is a "KEYSTONE MERCY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0272804 . This is a "CIGNA HEALTH PLAN PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0823424000 . This is a "AMERIHEALTH NEW JERSEY HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001850 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 781909 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0823424000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002437836 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0508032 . This is a "CIGNA HEALTH PLAN HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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