Provider Demographics
NPI:1962777599
Name:ALLIANCE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ALLIANCE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:BERRYHILL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RCP
Authorized Official - Phone:432-580-0171
Mailing Address - Street 1:2333 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4209
Mailing Address - Country:US
Mailing Address - Phone:432-580-0171
Mailing Address - Fax:432-580-7686
Practice Address - Street 1:10643 SENTINEL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3811
Practice Address - Country:US
Practice Address - Phone:210-737-2444
Practice Address - Fax:210-737-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0046215332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010067901Medicaid