Basic Information
| Provider Information | |||||||||
| NPI: | 1285719997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA MEDICAL CENTER, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1689 | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287291689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288915524 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 FORT BRAGG RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283036804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102213300 | ||||||||
| FaxNumber: | 9102213302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 08/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | OJO | ||||||||
| AuthorizedOfficialFirstName: | BABATUNDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9102213300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9901274 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1246H | 01 | NC | BCBS | OTHER | 891246H | 05 | NC | MEDICAID |