=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346342169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE HEALTHCARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 09/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3680 NW SAMARITAN DR
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-754-1150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 BAYVIEW CIRCLE SUITE 400
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-2984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-544-3215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC VP & CFO
-----------------------------------------------------
Name | RHONDA LONGMORE-GRUND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-544-3215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | ORE-91045
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------