Provider Demographics
NPI:1902852551
Name:ALLSTATE MED SUPPLIES, INC.
Entity Type:Organization
Organization Name:ALLSTATE MED SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-209-9176
Mailing Address - Street 1:4602 N 16TH ST
Mailing Address - Street 2:SUITE #305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5189
Mailing Address - Country:US
Mailing Address - Phone:602-234-4785
Mailing Address - Fax:
Practice Address - Street 1:4602 N 16TH ST
Practice Address - Street 2:SUITE #305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5189
Practice Address - Country:US
Practice Address - Phone:602-234-4785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5706620001Medicare PIN