MEDICARE: ALLIANCE MEDICAL 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0046215	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962777599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2333 E 8TH ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4209
Country	:	US
Telephone Number	:	432-580-0171
Fax Number	:	432-580-7686

Provider Business Practice Location Address
First Line	:	10643 SENTINEL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-3811
Country	:	US
Telephone Number	:	210-737-2444
Fax Number	:	210-737-2445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL DARREN BERRYHILL
Credential	:	RRT,RCP
Telephone Number	:	432-580-0171

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/05/2013

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