Provider Demographics
NPI:1740836311
Name:ALPHA MEDICAL PROVIDERS
Entity type:Organization
Organization Name:ALPHA MEDICAL PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MISA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-756-6120
Mailing Address - Street 1:2477 CINGOLI ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1634
Mailing Address - Country:US
Mailing Address - Phone:702-756-6120
Mailing Address - Fax:
Practice Address - Street 1:2477 CINGOLI ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1634
Practice Address - Country:US
Practice Address - Phone:702-756-6120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-10
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty