Healthcare Provider Details

I. General information

NPI: 1548621311
Provider Name (Legal Business Name): ALLIANCE PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 MORRIS RD
HAMILTON OH
45011-5417
US

IV. Provider business mailing address

1 PRESTIGE PL SUITE 550
MIAMISBURG OH
45342-3794
US

V. Phone/Fax

Practice location:
  • Phone: 513-261-6540
  • Fax: 513-261-6549
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY Y KO
Title or Position: CFO
Credential:
Phone: 937-558-3223