Healthcare Provider Details

I. General information

NPI: 1558753277
Provider Name (Legal Business Name): ALPHA MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 15TH ST
WORLAND WY
82401-3531
US

IV. Provider business mailing address

401 E 8TH ST SUITE 214-953
SIOUX FALLS SD
57103-7011
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500A
License Number StateWY

VIII. Authorized Official

Name: MARSHALL KEITH BROWN
Title or Position: SOLE OWNER
Credential: D.O.
Phone: 605-695-1541