MEDICARE: ALPHA-1 MEDICAL SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	HHC7803	FL

General Provider Information

NPI Number	:	1740477561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA-1 MEDICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	1037 W US HIGHWAY 90 STE 120
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3740
Country	:	US
Telephone Number	:	386-961-9113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 W US HIGHWAY 90 STE 120
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3740
Country	:	US
Telephone Number	:	386-961-9113
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL WELTON HEPPNER
Credential	:
Telephone Number	:	386-755-4734

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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