Healthcare Provider Details

I. General information

NPI: 1902746852
Provider Name (Legal Business Name): ALLY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH WAY DR
POTOSI MO
63664-1420
US

IV. Provider business mailing address

23 CORPORATE PLAZA DR STE 150
NEWPORT BEACH CA
92660-7908
US

V. Phone/Fax

Practice location:
  • Phone: 314-827-4701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AFNAN R TARIQ
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 314-265-6801