1376618124 NPI number — ALLIANCE HOSPITAL, LTD

Table of content: (NPI 1376618124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376618124 NPI number — ALLIANCE HOSPITAL, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE HOSPITAL, LTD
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:
1376618124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 ADAMS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79761-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-550-1000
Provider Business Mailing Address Fax Number:
432-580-4116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 ADAMS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-550-1000
Provider Business Practice Location Address Fax Number:
432-580-4116
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTOIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
432-550-1902

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007955 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282N00000X , with the licence number: 007955 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 10014148 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH1023 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88374327 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com