Healthcare Provider Details

I. General information

NPI: 1487642195
Provider Name (Legal Business Name): ALPHA AMBULATORY SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 CAPITAL CIR NE SUITE 200
TALLAHASSEE FL
32308-4390
US

IV. Provider business mailing address

PO BOX 13029
TALLAHASSEE FL
32317-3029
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-0033
  • Fax: 850-422-0201
Mailing address:
  • Phone: 850-385-0033
  • Fax: 850-422-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number829
License Number StateFL

VIII. Authorized Official

Name: DR. ISSAC MOORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-385-0033