MEDICARE: ALLIANCE CONVALESCENT AND SURGICAL SUPPLY 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
1	332BC3200X	Customized Equipment (DME)	B159424	DC

General Provider Information

NPI Number	:	1871632349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE CONVALESCENT AND SURGICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	1217 BRENTWOOD RD NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-1019
Country	:	US
Telephone Number	:	202-526-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 BRENTWOOD RD NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-1019
Country	:	US
Telephone Number	:	202-526-2066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BENJAMIN JOHNSON GINYARD
Credential	:
Telephone Number	:	202-526-2066

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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