Provider Demographics
NPI:1235578287
Name:ALPHA OMEGA ALLIANCE INC
Entity Type:Organization
Organization Name:ALPHA OMEGA ALLIANCE INC
Other - Org Name:RIVIERA BEACH URGENT CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MCAP SAP CTTP
Authorized Official - Phone:561-899-9140
Mailing Address - Street 1:31 W 20TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6155
Mailing Address - Country:US
Mailing Address - Phone:561-510-0471
Mailing Address - Fax:561-331-2715
Practice Address - Street 1:31 W 20TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6155
Practice Address - Country:US
Practice Address - Phone:561-510-0471
Practice Address - Fax:561-331-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X, 261Q00000X
261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty