Provider Demographics
NPI:1891873683
Name:ALPHA CARE CORPORATION
Entity Type:Organization
Organization Name:ALPHA CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAI
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-2017
Mailing Address - Street 1:PO BOX 4047
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25364-4047
Mailing Address - Country:US
Mailing Address - Phone:304-720-2017
Mailing Address - Fax:304-720-0888
Practice Address - Street 1:4813 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1948
Practice Address - Country:US
Practice Address - Phone:304-720-2017
Practice Address - Fax:304-720-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20569261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1806389000Medicaid
WV9353911Medicare PIN
WV1806389000Medicaid