MEDICARE: ALLIANCE PRIMARY CARE

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619149309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE PRIMARY CARE

Provider Business Mailing Address
First Line	:	3200 BURNET AVE
Second Line	:	1 RIDGEWAY
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3019
Country	:	US
Telephone Number	:	513-585-8173
Fax Number	:	513-585-6146

Provider Business Practice Location Address
First Line	:	4631 RIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1028
Country	:	US
Telephone Number	:	513-631-1268
Fax Number	:	513-366-4121

Authorized Official
Title or Position	:	DIRECTOR OF PATIENT ACCOUNTS
Name	:	JAMES LARSON
Credential	:
Telephone Number	:	513-585-9336

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	04/02/2008

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Directions to “ALLIANCE PRIMARY CARE ” Practice Location

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