Provider Demographics
NPI:1568772036
Name:MEDICAL ALLIANCE GROUP OF TEXAS, LLC
Entity Type:Organization
Organization Name:MEDICAL ALLIANCE GROUP OF TEXAS, LLC
Other - Org Name:SAN ANGELO HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:325-944-8916
Mailing Address - Street 1:1513 DARLENE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-944-8916
Mailing Address - Fax:325-944-8929
Practice Address - Street 1:2525 S JOHNSON STE A
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-949-2612
Practice Address - Fax:325-944-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies