Provider Demographics
NPI:1407119886
Name:ALLEGIANCE MEDICAL, CORP
Entity Type:Organization
Organization Name:ALLEGIANCE MEDICAL, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-603-6205
Mailing Address - Street 1:268 LUZENA AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4435
Mailing Address - Country:US
Mailing Address - Phone:707-330-6114
Mailing Address - Fax:
Practice Address - Street 1:1410 OAK ST
Practice Address - Street 2:ATTN: KURTIS M. DOERR ALLEGIANCE MEDICAL, LLC
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4604
Practice Address - Country:US
Practice Address - Phone:541-603-6205
Practice Address - Fax:541-228-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies