Provider Demographics
NPI:1346541232
Name:ALLIANCE HEALTHCARE ENTERPRISE
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:832-932-7952
Mailing Address - Street 1:8323 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 565
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1615
Mailing Address - Country:US
Mailing Address - Phone:832-932-7952
Mailing Address - Fax:281-888-3675
Practice Address - Street 1:8323 SOUTHWEST FWY
Practice Address - Street 2:SUITE 565
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1615
Practice Address - Country:US
Practice Address - Phone:832-932-7952
Practice Address - Fax:281-888-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNOT ISSUEDMedicare UPIN