MEDICARE: ALPHA MEDICAL SUPPLIES, LLC

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		NV

General Provider Information

NPI Number	:	1932172368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	812 E SAHARA AVE
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2970
Country	:	US
Telephone Number	:	702-369-9519
Fax Number	:	702-369-9144

Provider Business Practice Location Address
First Line	:	812 E SAHARA AVE
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2970
Country	:	US
Telephone Number	:	702-737-7090
Fax Number	:	702-737-7092

Authorized Official
Title or Position	:	MEMBER/OWNEER
Name	:	MR. MAXIM S. BOROVIK X
Credential	:
Telephone Number	:	702-369-9519

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	10/18/2007

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