Healthcare Provider Details

I. General information

NPI: 1609829647
Provider Name (Legal Business Name): ALPHA AND OMEGA FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 GORMAN AVE.
ELKINS WV
26241
US

IV. Provider business mailing address

804 GORMAN AVE.
ELKINS WV
26241
US

V. Phone/Fax

Practice location:
  • Phone: 304-642-3028
  • Fax:
Mailing address:
  • Phone: 304-642-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWV

VIII. Authorized Official

Name: MR. STEVEN R TONEY
Title or Position: OWNER
Credential: M.D.
Phone: 304-636-2696