Provider Demographics
NPI:1609042449
Name:ALPHA PULMONARY CRITICAL CARE CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:ALPHA PULMONARY CRITICAL CARE CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OYEYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FABUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-673-7110
Mailing Address - Street 1:PO BOX 12257
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8257
Mailing Address - Country:US
Mailing Address - Phone:817-338-0400
Mailing Address - Fax:817-338-0401
Practice Address - Street 1:508 S ADAMS ST
Practice Address - Street 2:SUITE 518
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2147
Practice Address - Country:US
Practice Address - Phone:817-338-0400
Practice Address - Fax:817-338-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197024601Medicaid
TX00Z374Medicare PIN
TX197024601Medicaid