Provider Demographics
NPI:1861716896
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:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:BERRYHILL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:432-580-0171
Mailing Address - Street 1:423 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5835
Mailing Address - Country:US
Mailing Address - Phone:432-620-0319
Mailing Address - Fax:432-620-0668
Practice Address - Street 1:423 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5835
Practice Address - Country:US
Practice Address - Phone:432-620-0319
Practice Address - Fax:432-620-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
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
TX0930630001Medicare NSC