Provider Demographics
NPI:1578997573
Name:ALPHA OMEGA ALLIANCE INC
Entity Type:Organization
Organization Name:ALPHA OMEGA ALLIANCE INC
Other - Org Name:RIVIERA BEACH URGENT & PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-899-9149
Mailing Address - Street 1:31 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6155
Mailing Address - Country:US
Mailing Address - Phone:561-899-9140
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
Practice Address - Country:US
Practice Address - Phone:561-229-1659
Practice Address - Fax:561-331-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015016000Medicaid