=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891945044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH ALLIANCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 E SIMPSON ST
-----------------------------------------------------
City | ALLIANCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44601-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-823-3856
-----------------------------------------------------
Fax | 330-829-9372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 E SIMPSON ST
-----------------------------------------------------
City | ALLIANCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44601-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-823-3856
-----------------------------------------------------
Fax | 330-829-9372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING/REIMBURSEMENT
-----------------------------------------------------
Name | MRS. DEBORAH KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-823-3856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35057172
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------