Healthcare Provider Details

I. General information

NPI: 1649482712
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S MAIN ST
MOSCOW ID
83843
US

IV. Provider business mailing address

100 BAYVIEW CIR SUITE 400
NEWPORT BEACH CA
92660-2983
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-4511
  • Fax:
Mailing address:
  • Phone: 800-544-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA LONGMORE-GRUND
Title or Position: EXEC VP & CFO
Credential:
Phone: 800-544-3215