1891049722 NPI number — ALLIANCE PHYSICIANS INC

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 1891049722 NPI number — ALLIANCE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE PHYSICIANS INC
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:
Provider Other Organization Name Type Code:
6
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:
1891049722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESTIGE PL
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-3794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-752-2306
Provider Business Mailing Address Fax Number:
937-522-7626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3359 KEMP RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45431-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-562-2290
Provider Business Practice Location Address Fax Number:
937-562-2295
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KO
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
937-588-3208

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0077022 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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