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?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty