Healthcare Provider Details

I. General information

NPI: 1083986442
Provider Name (Legal Business Name): ALLIANCE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N BROADWAY ST
LEBANON OH
45036-2590
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3598
US

V. Phone/Fax

Practice location:
  • Phone: 513-228-1552
  • Fax: 513-228-1558
Mailing address:
  • Phone: 937-384-4838
  • Fax: 937-384-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35048340
License Number StateOH

VIII. Authorized Official

Name: TIM KO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 937-558-3208