Healthcare Provider Details

I. General information

NPI: 1326244096
Provider Name (Legal Business Name): ALLIANCE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

IV. Provider business mailing address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax: 707-385-2157
Mailing address:
  • Phone: 707-433-5494
  • Fax: 707-385-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberHAP03923F
License Number StateCA

VIII. Authorized Official

Name: JOAN CHURCHILL
Title or Position: CEO
Credential:
Phone: 707-385-2306