1881675247 NPI number — ALPHA MEDICAL AIDS, INC.

Table of content: (NPI 1881675247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881675247 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:
1881675247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3506 SEMINOLE TRAIL
Provider Second Line Business Mailing Address:
ROUTE 29
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:
434-710-4033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3506 SEMINOLE TRAIL
Provider Second Line Business Practice Location Address:
ROUTE 29
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-8665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-971-7300
Provider Business Practice Location Address Fax Number:
434-971-3739
Provider Enumeration Date:
11/10/2005

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




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