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General NPI Number Information
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NPI Number | 1033534276
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Entity Type | Organization
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Legal Business Name | ALLIANCE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1623 SOUTH WELLS AVENUE
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-489-1450
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Fax | 208-489-1451
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Provider Business Mailing Address
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Address Line | PO BOX 191050
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City | BOISE
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State | ID
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Zip | 83719-1050
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Country | US
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Telephone | 208-955-6500
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Fax | 208-955-6501
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LINDA BARNES
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Credential |
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Telephone | 208-985-1423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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