Provider Demographics
NPI:1497940365
Name:ALFA MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ALFA MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUREVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-680-5056
Mailing Address - Street 1:5956 S HELENA CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1041
Mailing Address - Country:US
Mailing Address - Phone:303-680-5056
Mailing Address - Fax:
Practice Address - Street 1:5956 S HELENA CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1041
Practice Address - Country:US
Practice Address - Phone:303-680-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92153526Medicaid