Provider Demographics
NPI:1376781880
Name:ALFA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ALFA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-279-4441
Mailing Address - Street 1:250 E SAINT CHARLES RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2472
Mailing Address - Country:US
Mailing Address - Phone:630-279-4441
Mailing Address - Fax:630-279-4449
Practice Address - Street 1:250 E SAINT CHARLES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2472
Practice Address - Country:US
Practice Address - Phone:630-279-4441
Practice Address - Fax:630-279-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19752-84480332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies