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
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568413920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 191050
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-1050
Country	:	US
Telephone Number	:	208-955-6500
Fax Number	:	208-955-6503

Provider Business Practice Location Address
First Line	:	10482 W CARLTON BAY DR
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-5143
Country	:	US
Telephone Number	:	208-955-6500
Fax Number	:	208-955-6503

Authorized Official
Title or Position	:	CREDENTIALING MGR
Name	:	LINDA BARNES
Credential	:
Telephone Number	:	208-985-1423

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	02/17/2025

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Directions to “ALLIANCE MEDICAL GROUP, LLC ” Practice Location

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