Provider Demographics
NPI:1750320271
Name:ALFA MEDICAL CLINIC, PA
Entity Type:Organization
Organization Name:ALFA MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-588-9997
Mailing Address - Street 1:PO BOX 77188
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271-7004
Mailing Address - Country:US
Mailing Address - Phone:704-588-9997
Mailing Address - Fax:704-588-9499
Practice Address - Street 1:2540 W ARROWOOD RD
Practice Address - Street 2:STE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6197
Practice Address - Country:US
Practice Address - Phone:704-588-9997
Practice Address - Fax:704-588-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917593Medicaid
NC13155OtherBCBS
NC8913155Medicaid
NCP00275272OtherMEDICARE RR
NC2324795HMedicare PIN
NCP00275272OtherMEDICARE RR
NC13155OtherBCBS
NC8913155Medicaid
NC2324795FMedicare PIN
NC2020729Medicare PIN