MEDICARE: ALLIANCE HEALTHCARE GPO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1275032278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTHCARE GPO LLC

Provider Business Mailing Address
First Line	:	14918 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1632
Country	:	US
Telephone Number	:	813-931-0000
Fax Number	:	813-264-6868

Provider Business Practice Location Address
First Line	:	14918 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1632
Country	:	US
Telephone Number	:	813-931-0000
Fax Number	:	813-264-6868

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	JOHN WOODS
Credential	:
Telephone Number	:	615-390-9757

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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