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NPI Code Detail

MEDICARE: ALLIANCE MEDICAL GROUP, LLC

MEDICARE: ALLIANCE MEDICAL GROUP, 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
1207Q00000XFamily Medicine PhysicianID

General Provider Information

NPI Number : 1457868002
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLIANCE MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 10482 W CARLTON BAY DR
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-5143
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1375 N HAPPY VALLEY RD
Second Line :
City : NAMPA
State : ID
Zip : 83687-5280
Country : US
Telephone Number : 208-809-2869
Fax Number : 208-809-2870
Authorized Official
Title or Position : CREDENTIALING MGR
Name : LINDA BARNES
Credential :
Telephone Number : 208-985-1423
Provider Enumeration Date : 01/04/2018
Last Update Date : 02/17/2025

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Directions to “ALLIANCE MEDICAL GROUP, LLC ” Practice Location

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