1184105298 NPI number — ALLIANCE PRIMARY CARE

Table of content: (NPI 1184105298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184105298 NPI number — ALLIANCE PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE PRIMARY CARE
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:
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:
1184105298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 591
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION BRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21791-0592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-937-6258
Provider Business Mailing Address Fax Number:
949-404-6023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION BRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21791-9102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-775-2622
Provider Business Practice Location Address Fax Number:
410-848-5629
Provider Enumeration Date:
08/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BAUGHER
Authorized Official First Name:
VICKY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-596-1720

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R139731 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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