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
StateLicense IDTaxonomies
MN3340236-2332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies