MEDICARE: ALPHA EXPRESS PRIMARY CARE 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	208000000X	Pediatrics Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1992671184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA EXPRESS PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	2626 S CARRIER PKWY STE 200
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-5014
Country	:	US
Telephone Number	:	469-251-8993
Fax Number	:	469-251-8995

Provider Business Practice Location Address
First Line	:	2626 S CARRIER PKWY STE 200
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-5014
Country	:	US
Telephone Number	:	469-251-8993
Fax Number	:	469-251-8995

Authorized Official
Title or Position	:	CEO
Name	:	OMOLARA ABITOYE
Credential	:	MD
Telephone Number	:	469-251-8993

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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Directions to “ALPHA EXPRESS PRIMARY CARE LLC ” Practice Location

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