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General NPI Number Information
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NPI Number | 1659950103
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Entity Type | Organization
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Legal Business Name | ALPHA AMERICAN MEDICAL SUPPLY PLLC
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1800 W HAWTHORNE LN STE N1-323
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City | WEST CHICAGO
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State | IL
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Zip | 60185-1845
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Country | US
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Telephone | 630-473-4770
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Fax | 630-621-9107
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Provider Business Mailing Address
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Address Line | 1800 W HAWTHORNE LN STE N1-323
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City | WEST CHICAGO
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State | IL
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Zip | 60185-1845
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Country | US
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Telephone | 630-473-4770
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Fax | 630-621-9107
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Authorized Official
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Title or Position | CEO / MANAGER
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Name | KALYAN RAJ BOLLA
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Credential |
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Telephone | 630-473-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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