Healthcare Provider Details

I. General information

NPI: 1073784765
Provider Name (Legal Business Name): ALLIANCE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD STE. 300
CINCINNATI OH
45209-1900
US

IV. Provider business mailing address

3200 BURNET AVE 1 RIDGEWAY
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-9700
  • Fax:
Mailing address:
  • Phone: 513-585-9009
  • Fax: 513-585-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LARSON
Title or Position: SENIOR DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 513-585-9336