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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 Physician

General Provider Information

NPI Number : 1629214960
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 : 4815 CLEVELAND BLVD
Second Line :
City : CALDWELL
State : ID
Zip : 83605-6501
Country : US
Telephone Number : 208-455-3545
Fax Number : 208-454-9690
Authorized Official
Title or Position : CREDENTIALING MGR
Name : LINDA BARNES
Credential :
Telephone Number : 208-985-1423
Provider Enumeration Date : 12/16/2008
Last Update Date : 02/17/2025

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Directions to “ALLIANCE MEDICAL GROUP, LLC ” Practice Location

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