Healthcare Provider Details

I. General information

NPI: 1265893549
Provider Name (Legal Business Name): ALPHA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 HARDING MEMORIAL PKWY
MARION OH
43302-6315
US

IV. Provider business mailing address

PO BOX 119
LOGAN WV
25601-0119
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-4090
  • Fax: 740-383-2850
Mailing address:
  • Phone: 304-896-5200
  • Fax: 304-896-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: EMAD Y MOUSA
Title or Position: DIRECTOR
Credential: MD
Phone: 412-680-6497