MEDICARE: ALLIANCE ASC, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1871050864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE ASC, LLC

Provider Business Mailing Address
First Line	:	21155 SOUTHWEST FWY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-7101
Country	:	US
Telephone Number	:	713-277-5679
Fax Number	:	281-810-1064

Provider Business Practice Location Address
First Line	:	21155 SOUTHWEST FWY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-7101
Country	:	US
Telephone Number	:	281-810-1060
Fax Number	:	281-810-1064

Authorized Official
Title or Position	:	ADMINISTRATOR/CEO
Name	:	MR. REGGIE ABRAHAM
Credential	:
Telephone Number	:	713-277-5679

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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