Healthcare Provider Details

I. General information

NPI: 1891888517
Provider Name (Legal Business Name): ALLIANCE URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9897 W. MCDOWELL RD
TOLLESON AZ
85353
US

IV. Provider business mailing address

9897 W. MCDOWELL RD
TOLLESON AZ
85353
US

V. Phone/Fax

Practice location:
  • Phone: 719-268-5305
  • Fax:
Mailing address:
  • Phone: 719-268-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number29590
License Number StateAZ

VIII. Authorized Official

Name: R MICHAEL BLUMHOFF
Title or Position: PARTNER
Credential: MD
Phone: 480-563-1058