Healthcare Provider Details

I. General information

NPI: 1891865366
Provider Name (Legal Business Name): ALLIANCE NEUROLOGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 S UNION AVE
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

270 E STATE ST SUITE 140
ALLIANCE OH
44601-4957
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-9389
  • Fax: 330-829-9372
Mailing address:
  • Phone: 330-823-4044
  • Fax: 330-829-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35047526S
License Number StateOH

VIII. Authorized Official

Name: CAROL E KLINE
Title or Position: CONTRACT CREDENTIALING
Credential:
Phone: 330-829-9389