MEDICARE: ALLIANCE MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies	41-91310-0000	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5421370001	OTHER	CO	NSC NUMBER

General Provider Information

NPI Number	:	1447269972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	4918 E COLFAX AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4918 E COLFAX AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1208
Country	:	US
Telephone Number	:	720-941-8487
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WOLDEYOHANNES ASSEFA
Credential	:
Telephone Number	:	720-941-8487

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

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