Provider Demographics
NPI:1902224884
Name:ALCAM MEDICAL INC
Entity Type:Organization
Organization Name:ALCAM MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-782-7000
Mailing Address - Street 1:1760 CHICAGO AVE
Mailing Address - Street 2:SUITE L21
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2300
Mailing Address - Country:US
Mailing Address - Phone:951-782-7000
Mailing Address - Fax:
Practice Address - Street 1:1281 N GENE AUTRY TRL
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5418
Practice Address - Country:US
Practice Address - Phone:951-782-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCAM MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier