MEDICARE: ALPHA MEDICAL EVALUATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1750568309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL EVALUATIONS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 19187
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73144-0187
Country	:	US
Telephone Number	:	405-255-9870
Fax Number	:	405-680-5076

Provider Business Practice Location Address
First Line	:	2 S COO Y YAH ST
Second Line	:
City	:	PRYOR
State	:	OK
Zip	:	74361-4636
Country	:	US
Telephone Number	:	405-255-9870
Fax Number	:	405-680-5076

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD EDWARD ANDERSON
Credential	:
Telephone Number	:	405-255-9870

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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