Provider Demographics
NPI:1912336611
Name:ALAMO CITY DURABLE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:ALAMO CITY DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:ALLIANCE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-737-2444
Mailing Address - Street 1:10643 SENTINEL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3811
Mailing Address - Country:US
Mailing Address - Phone:210-829-5900
Mailing Address - Fax:210-829-3760
Practice Address - Street 1:10643 SENTINEL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3811
Practice Address - Country:US
Practice Address - Phone:210-829-5900
Practice Address - Fax:210-829-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357136601Medicaid
TX1912336611Medicare NSC