Provider Demographics
NPI:1851539324
Name:ALEGRIA PHANKONSY FREEMOTION PLUS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ALEGRIA PHANKONSY FREEMOTION PLUS MEDICAL SUPPLY
Other - Org Name:ARIA MEDICAL ARBITRATIONS AND SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEGRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHANKONSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-982-3859
Mailing Address - Street 1:501 S RANCHO DR STE A1
Mailing Address - Street 2:A1 A2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4829
Mailing Address - Country:US
Mailing Address - Phone:702-982-3859
Mailing Address - Fax:702-982-1601
Practice Address - Street 1:501 S RANCHO DR STE A1
Practice Address - Street 2:A1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4829
Practice Address - Country:US
Practice Address - Phone:702-982-3859
Practice Address - Fax:702-982-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6256320001Medicare NSC