Provider Demographics
NPI:1366779779
Name:ALPHA MEDICAL
Entity type:Organization
Organization Name:ALPHA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-556-7828
Mailing Address - Street 1:PO BOX 12999
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-2999
Mailing Address - Country:US
Mailing Address - Phone:843-556-7828
Mailing Address - Fax:
Practice Address - Street 1:210 W 6TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6617
Practice Address - Country:US
Practice Address - Phone:843-832-4357
Practice Address - Fax:843-832-4986
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty