| Alpha And Omega Primary Health Care Inc | |
|
15865 Wyoming St Detroit MI 48238-1136 | |
| (313) 342-2576 | |
| Not Available |
| Full Name | Alpha And Omega Primary Health Care Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 15865 Wyoming St, Detroit, Michigan |
| Authorized Official Name and Position | Rickie Hardaway (OWNER) |
| Authorized Official Contact | 3133422576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alpha And Omega Primary Health Care Inc 15865 Wyoming St Detroit MI 48238-1136 Ph: () - | Alpha And Omega Primary Health Care Inc 15865 Wyoming St Detroit MI 48238-1136 Ph: (313) 342-2576 |
| NPI Number | 1770752495 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 04/29/2008 |
| Medicare PECOS PAC ID | 1355420829 |
|---|---|
| Medicare Enrollment ID | O20080508000588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770752495 | NPI | - | NPPES |
| 1316903198 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301061729 (Michigan) | Primary |
| 208000000X | Pediatrics | 4301061729 (Michigan) | Secondary |
| Provider Name | Rickie Hardaway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316903198 PECOS PAC ID: 1951388016 Enrollment ID: I20040707000088 |
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