Provider Demographics
NPI:1609976893
Name:ALLIANCE REHAB & MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ALLIANCE REHAB & MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:CRTS, ATS
Authorized Official - Phone:417-581-5747
Mailing Address - Street 1:2205 PETRUS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9206
Mailing Address - Country:US
Mailing Address - Phone:417-581-5747
Mailing Address - Fax:417-581-5762
Practice Address - Street 1:2205 PETRUS CIRCLE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9206
Practice Address - Country:US
Practice Address - Phone:417-581-5747
Practice Address - Fax:417-581-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626265607Medicaid
MO626265607Medicaid