1578791562 NPI number — ALLIANCE MEDICAL SOLUTIONS LLC

Table of content: (NPI 1578791562)

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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