Provider Demographics
NPI:1912435181
Name:ALPHA GROUP LLC
Entity Type:Organization
Organization Name:ALPHA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:NASHIKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-232-1939
Mailing Address - Street 1:2920 N CASCADE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6264
Mailing Address - Country:US
Mailing Address - Phone:719-362-4590
Mailing Address - Fax:719-362-4591
Practice Address - Street 1:2920 N CASCADE AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6264
Practice Address - Country:US
Practice Address - Phone:719-362-4590
Practice Address - Fax:719-362-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CO208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty