Provider Demographics
NPI: | 1942802582 |
---|---|
Name: | ALPHA AND OMEGA HEALTH SERVICES LLC |
Entity Type: | Organization |
Organization Name: | ALPHA AND OMEGA HEALTH SERVICES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SANDRA |
Authorized Official - Middle Name: | DANETTE |
Authorized Official - Last Name: | LOTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NP |
Authorized Official - Phone: | 601-675-7142 |
Mailing Address - Street 1: | PO BOX 612 |
Mailing Address - Street 2: | |
Mailing Address - City: | MENDENHALL |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 39114-0612 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 601-675-7142 |
Mailing Address - Fax: | 601-675-7143 |
Practice Address - Street 1: | 1847 SIMPSON HIGHWAY 149 |
Practice Address - Street 2: | |
Practice Address - City: | MENDENHALL |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39114-3439 |
Practice Address - Country: | US |
Practice Address - Phone: | 601-675-7142 |
Practice Address - Fax: | 601-675-7143 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-09 |
Last Update Date: | 2020-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |