Provider Demographics
NPI:1932172368
Name:ALPHA MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ALPHA MEDICAL SUPPLIES, LLC
Other - Org Name:ALPHA MEDICAL SUPPLIES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNEER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOROVIK
Authorized Official - Suffix:X
Authorized Official - Credentials:
Authorized Official - Phone:702-369-9519
Mailing Address - Street 1:812 E SAHARA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2970
Mailing Address - Country:US
Mailing Address - Phone:702-369-9519
Mailing Address - Fax:702-369-9144
Practice Address - Street 1:812 E SAHARA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2970
Practice Address - Country:US
Practice Address - Phone:702-737-7090
Practice Address - Fax:702-737-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV537929290001Medicare ID - Type Unspecified