1578791562 NPI number — ALLIANCE MEDICAL SOLUTIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578791562 NPI number — ALLIANCE MEDICAL SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE MEDICAL SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIANCE BRACING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578791562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6009 BROWNSBORO PARK BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-1291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-253-6881
Provider Business Mailing Address Fax Number:
502-253-6882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9736 DAYTON PIKE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SODDY DAISY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37379-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-332-5155
Provider Business Practice Location Address Fax Number:
423-332-5195
Provider Enumeration Date:
06/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, OPERATIONS
Authorized Official Telephone Number:
502-253-6881

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000791 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1455152 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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