MEDICARE: ALPHA TELEHEALTH LLC

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	163WC0400X	Case Management Registered Nurse	35043909	OH

General Provider Information

NPI Number	:	1922491232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA TELEHEALTH LLC

Provider Business Mailing Address
First Line	:	3380 ERIE AVE
Second Line	:	SUITE 240
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-334-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 ERIE AVE
Second Line	:	SUITE 240
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-334-0073
Fax Number	:

Authorized Official
Title or Position	:	PRESIDAENT
Name	:	DR. JOSE LUIS CHAVEZ
Credential	:	M.D.
Telephone Number	:	513-334-0073

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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Directions to “ALPHA TELEHEALTH LLC ” Practice Location

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