Provider Demographics
NPI:1487642195
Name:ALPHA AMBULATORY SURGERY INC.
Entity Type:Organization
Organization Name:ALPHA AMBULATORY SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISSAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-385-0033
Mailing Address - Street 1:PO BOX 13029
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3029
Mailing Address - Country:US
Mailing Address - Phone:850-385-0033
Mailing Address - Fax:850-422-0201
Practice Address - Street 1:2160 CAPITAL CIR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4390
Practice Address - Country:US
Practice Address - Phone:850-385-0033
Practice Address - Fax:850-422-0201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL829261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1150Medicare ID - Type Unspecified