Healthcare Provider Details

I. General information

NPI: 1245540871
Provider Name (Legal Business Name): ACCESS ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2010
Last Update Date: 10/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SUNRISE RD
OREGON WI
53575-2421
US

IV. Provider business mailing address

1545 SUNRISE RD
OREGON WI
53575-2421
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number43432-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43432-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number43432-020
License Number StateWI

VIII. Authorized Official

Name: YASMIN YUSUF
Title or Position: MEDICAL DIRECTOR AND CEO
Credential: MD
Phone: 608-443-9111