=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568485050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE FAMILY HEALTH CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9323 MIDLOTHIAN TPKE SUITE E
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-5575
-----------------------------------------------------
Fax | 804-323-0311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9323 MIDLOTHIAN TURNPIKE SUITE E
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-5575
-----------------------------------------------------
Fax | 804-323-0311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. ALFREDA BOOKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-323-5575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101049033
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------