MEDICARE: ALPHA MEDICAL SUPPLIES

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	332BX2000X	Oxygen Equipment & Supplies (DME)	1001100581	NV

General Provider Information

NPI Number	:	1104870617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	4676 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1503
Country	:	US
Telephone Number	:	702-388-1299
Fax Number	:	702-798-1299

Provider Business Practice Location Address
First Line	:	4676 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1503
Country	:	US
Telephone Number	:	702-388-1299
Fax Number	:	702-798-1299

Authorized Official
Title or Position	:	CHAIRMAN/PART OWNER
Name	:	MR. CHRISTIAN IGBOAMAZU
Credential	:
Telephone Number	:	702-388-1299

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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