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General NPI Number Information
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NPI Number | 1194751776
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 2091 BOX BUTTE AVE, SUITE 500
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City | ALLIANCE
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State | NE
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Zip | 69301
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Country | US
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Telephone | 308-762-2534
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Fax | 308-762-2764
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Provider Business Mailing Address
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Address Line | 2091 BOX BUTTE AVE, SUITE 500
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City | ALLIANCE
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State | NE
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Zip | 69301
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Country | US
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Telephone | 308-762-2534
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Fax | 308-762-2764
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARTI D. JORDAN
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Credential |
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Telephone | 308-762-2534
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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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