1326238288 NPI number — ALPHA -OMEGA ENDOCRINOLOGY DIABETES &METABOLISM CENTER, PC.

Table of content: (NPI 1326238288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326238288 NPI number — ALPHA -OMEGA ENDOCRINOLOGY DIABETES &METABOLISM CENTER, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA -OMEGA ENDOCRINOLOGY DIABETES &METABOLISM CENTER, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1326238288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11111 N SCOTTSDALE RD STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-6737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-922-3009
Provider Business Mailing Address Fax Number:
480-922-3103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 N SCOTTSDALE RD STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-6737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-922-3009
Provider Business Practice Location Address Fax Number:
480-922-3103
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEKELE
Authorized Official First Name:
GENENE
Authorized Official Middle Name:
MERGIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-922-3009

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  25581 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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