Provider Demographics
NPI:1528693611
Name:ALLY MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ALLY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOLGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-493-5657
Mailing Address - Street 1:5258 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7152
Mailing Address - Country:US
Mailing Address - Phone:312-493-5657
Mailing Address - Fax:317-526-5064
Practice Address - Street 1:9247 N MERIDIAN ST STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1879
Practice Address - Country:US
Practice Address - Phone:312-493-5657
Practice Address - Fax:317-526-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies