Provider Demographics
NPI:1598755746
Name:ALPHA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ALPHA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, COF
Authorized Official - Phone:865-966-2371
Mailing Address - Street 1:11226 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2808
Mailing Address - Country:US
Mailing Address - Phone:865-966-2371
Mailing Address - Fax:865-966-2381
Practice Address - Street 1:11226 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2808
Practice Address - Country:US
Practice Address - Phone:865-966-2371
Practice Address - Fax:865-966-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN786332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454175Medicaid
TN4019533OtherBLUE CROSS ID
TN4210810001Medicare NSC