MEDICARE: ALLIANCE HEALTH CENTERS, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1730928953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	2700 LAFAYETTE ST STE 110
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1100
Country	:	US
Telephone Number	:	260-266-0780
Fax Number	:	260-266-0785

Provider Business Practice Location Address
First Line	:	909 ELMROW DR.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3173
Country	:	US
Telephone Number	:	260-266-0780
Fax Number	:	260-266-0785

Authorized Official
Title or Position	:	DO
Name	:	ERIC ALLAN SHOEMAKER
Credential	:
Telephone Number	:	602-660-7802

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	05/20/2024

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