Provider Demographics
NPI:1609894294
Name:ALFA DIAGNOSTIC MOBILE SERVICES, INC
Entity Type:Organization
Organization Name:ALFA DIAGNOSTIC MOBILE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-554-1737
Mailing Address - Street 1:8370 W FLAGLER ST
Mailing Address - Street 2:STE246
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2040
Mailing Address - Country:US
Mailing Address - Phone:305-220-9293
Mailing Address - Fax:305-554-1737
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE 246
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2040
Practice Address - Country:US
Practice Address - Phone:305-220-9293
Practice Address - Fax:305-554-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9996OtherBCBSFL PROVIDER NUMBER
FL5961190001Medicare NSC