Provider Demographics
NPI:1265893549
Name:ALPHA MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ALPHA MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-680-6497
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0119
Mailing Address - Country:US
Mailing Address - Phone:304-896-5200
Mailing Address - Fax:304-896-5300
Practice Address - Street 1:1043 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6315
Practice Address - Country:US
Practice Address - Phone:740-383-4090
Practice Address - Fax:740-383-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2873029Medicaid
OH2873029Medicaid