Healthcare Provider Details

I. General information

NPI: 1457868002
Provider Name (Legal Business Name): ALLIANCE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N HAPPY VALLEY RD
NAMPA ID
83687-5280
US

IV. Provider business mailing address

10482 W CARLTON BAY DR
GARDEN CITY ID
83714-5143
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2869
  • Fax: 208-809-2870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateID

VIII. Authorized Official

Name: LINDA BARNES
Title or Position: CREDENTIALING MGR
Credential:
Phone: 208-985-1423