Healthcare Provider Details

I. General information

NPI: 1336866953
Provider Name (Legal Business Name): ALPHA MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 LOGAN ST
WILLIAMSON WV
25661-3607
US

IV. Provider business mailing address

PO BOX 1635
WILLIAMSON WV
25661-1635
US

V. Phone/Fax

Practice location:
  • Phone: 606-424-6809
  • Fax:
Mailing address:
  • Phone: 606-424-6809
  • Fax:

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: BILLY MOSELEY
Title or Position: MANAGING OWNER
Credential:
Phone: 606-424-6809