Provider Demographics
NPI:1124185384
Name:ALLEGIANCE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ALLEGIANCE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:318-865-7111
Mailing Address - Street 1:1532 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4604
Mailing Address - Country:US
Mailing Address - Phone:318-865-7111
Mailing Address - Fax:318-865-7771
Practice Address - Street 1:1532 IRVING PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4604
Practice Address - Country:US
Practice Address - Phone:318-865-7111
Practice Address - Fax:318-865-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1109771Medicaid
TX1476756-01Medicaid
LAG4270OtherBCBS
LA4133360001Medicare NSC