Healthcare Provider Details

I. General information

NPI: 1891945044
Provider Name (Legal Business Name): HEALTH ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 E SIMPSON ST
ALLIANCE OH
44601-4219
US

IV. Provider business mailing address

149 E SIMPSON ST
ALLIANCE OH
44601-4219
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-3856
  • Fax: 330-829-9372
Mailing address:
  • Phone: 330-823-3856
  • Fax: 330-829-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35057172
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBORAH KING
Title or Position: BILLING/REIMBURSEMENT
Credential:
Phone: 330-823-3856