Provider Demographics
NPI: | 1801021233 |
---|---|
Name: | ALPHA MEDICAL SUPPLIES |
Entity Type: | Organization |
Organization Name: | ALPHA MEDICAL SUPPLIES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | BANNERMAN-THOMPSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 651-486-6465 |
Mailing Address - Street 1: | 2489 RICE ST |
Mailing Address - Street 2: | SUITE 80 |
Mailing Address - City: | ROSEVILLE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55113-3738 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-486-6465 |
Mailing Address - Fax: | 651-486-6465 |
Practice Address - Street 1: | 2489 RICE ST |
Practice Address - Street 2: | SUITE 80 |
Practice Address - City: | ROSEVILLE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55113-3738 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-486-6465 |
Practice Address - Fax: | 651-486-6465 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-29 |
Last Update Date: | 2009-05-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 3340236-2 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |