Provider Demographics
NPI:1164586103
Name:ALCAM MEDICAL, INC.
Entity type:Organization
Organization Name:ALCAM MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-782-7000
Mailing Address - Street 1:1660 CHICAGO AVE STE M13
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2033
Mailing Address - Country:US
Mailing Address - Phone:866-847-7187
Mailing Address - Fax:877-310-1729
Practice Address - Street 1:1660 CHICAGO AVE STE M13
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2033
Practice Address - Country:US
Practice Address - Phone:866-847-7187
Practice Address - Fax:877-310-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54736332B00000X
CA46553332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5890970001Medicare NSC