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General NPI Number Information
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NPI Number | 1740477561
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Entity Type | Organization
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Legal Business Name | ALPHA-1 MEDICAL SERVICES INC.
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 1037 W US HIGHWAY 90 STE 120
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City | LAKE CITY
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State | FL
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Zip | 32055-3740
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Country | US
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Telephone | 386-961-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 W US HIGHWAY 90 STE 120
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City | LAKE CITY
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State | FL
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Zip | 32055-3740
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Country | US
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Telephone | 386-961-9113
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL WELTON HEPPNER
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Credential |
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Telephone | 386-755-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | HHC7803
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License Number State | FL
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