Provider Demographics
NPI:1093443830
Name:ALLIANCE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-334-6681
Mailing Address - Street 1:9725 E HAMPDEN AVE STE 102B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4916
Mailing Address - Country:US
Mailing Address - Phone:720-334-6681
Mailing Address - Fax:
Practice Address - Street 1:9725 E HAMPDEN AVE STE 102B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4916
Practice Address - Country:US
Practice Address - Phone:720-334-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies