MEDICARE: ALLIANCE HEALTHCARE CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center
2	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1194051946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTHCARE CLINIC CORP

Provider Business Mailing Address
First Line	:	4311 ANDERSON RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7358
Country	:	US
Telephone Number	:	321-251-7627
Fax Number	:	321-445-6072

Provider Business Practice Location Address
First Line	:	4311 ANDERSON RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7358
Country	:	US
Telephone Number	:	321-251-7627
Fax Number	:	321-445-6072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSAURA CASTRO
Credential	:
Telephone Number	:	321-251-7627

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	10/29/2009

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