Provider Demographics
NPI:1295059285
Name:ALPHA AND OMEGA MEDICAL INC.
Entity type:Organization
Organization Name:ALPHA AND OMEGA MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:U
Authorized Official - Last Name:AYANGBILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-786-8682
Mailing Address - Street 1:1623 2ND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8643
Mailing Address - Country:US
Mailing Address - Phone:309-786-8682
Mailing Address - Fax:309-786-8682
Practice Address - Street 1:1623 2ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8643
Practice Address - Country:US
Practice Address - Phone:309-786-8682
Practice Address - Fax:309-786-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies