1235554650 NPI number — ALLIANCE PHYSICIANS, INC.

Table of content: (NPI 1235554650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235554650 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:
KETTERING SURGICAL ASSOCIATES
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:
1235554650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2019
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:
1251 NILLES RD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-829-7133
Provider Business Practice Location Address Fax Number:
937-829-7134
Provider Enumeration Date:
02/21/2014

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:
937-558-3223

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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