Provider Demographics
NPI:1477644813
Name:ALLIANCE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-895-8040
Mailing Address - Street 1:2260 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2316
Mailing Address - Country:US
Mailing Address - Phone:651-895-8040
Mailing Address - Fax:651-895-8070
Practice Address - Street 1:2260 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2316
Practice Address - Country:US
Practice Address - Phone:651-895-8040
Practice Address - Fax:651-895-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNOT REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1036600001Medicare NSC