Provider Demographics
NPI:1104870617
Name:ALPHA MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ALPHA MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PART OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBOAMAZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-388-1299
Mailing Address - Street 1:4676 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1503
Mailing Address - Country:US
Mailing Address - Phone:702-388-1299
Mailing Address - Fax:702-798-1299
Practice Address - Street 1:4676 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1503
Practice Address - Country:US
Practice Address - Phone:702-388-1299
Practice Address - Fax:702-798-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1001100581332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5152170001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT