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NPI Code Detail

MEDICARE: ALLEGIANCE GROUP DIVERSIFIED, INC.

MEDICARE: ALLEGIANCE GROUP DIVERSIFIED, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesB911899VA
2251E00000XHome Health AgencyB911896VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B911884OTHERVABUSINESS PROFESSIONAL AND OCCUPATIONAL LICENSE
2B911899OTHERVABUSINESS PROFESSIONAL AND OCCUPATIONAL LICENSE
3B911896OTHERVABUSINESS PROFESSIONAL AND OCCUPATIONAL LICENSE

General Provider Information

NPI Number : 1366678518
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLEGIANCE GROUP DIVERSIFIED, INC.
Provider Business Mailing Address
First Line : 101 E HOLLY AVE
Second Line : SUITE 4
City : STERLING
State : VA
Zip : 20164-5402
Country : US
Telephone Number : 703-615-1974
Fax Number : 703-738-7009
Provider Business Practice Location Address
First Line : 101 E HOLLY AVE
Second Line : SUITE 4
City : STERLING
State : VA
Zip : 20164-5402
Country : US
Telephone Number : 703-615-1974
Fax Number : 703-738-7009
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : MS. DENEEN ANNETTE PALMER
Credential :
Telephone Number : 703-615-1974
Provider Enumeration Date : 06/02/2009
Last Update Date : 06/02/2009

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