Provider Demographics
| NPI: | 1437125572 |
|---|---|
| Name: | ALLIANCE PHYSICIANS INC |
| Entity Type: | Organization |
| Organization Name: | ALLIANCE PHYSICIANS INC |
| Other - Org Name: | KETTERING HEALTH MEDICAL GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TIMOTHY |
| Authorized Official - Middle Name: | Y |
| Authorized Official - Last Name: | KO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 937-558-3223 |
| Mailing Address - Street 1: | 1 PRESTIGE PL |
| Mailing Address - Street 2: | SUITE 550 |
| Mailing Address - City: | MIAMISBURG |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45342-3794 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 937-762-1300 |
| Mailing Address - Fax: | 937-762-1319 |
| Practice Address - Street 1: | 1827 WOODMAN CENTER DR |
| Practice Address - Street 2: | |
| Practice Address - City: | KETTERING |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45420-1157 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 937-558-3223 |
| Practice Address - Fax: | 937-558-3247 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-02-28 |
| Last Update Date: | 2023-01-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 2712872 | Medicaid | |
| OH | 2372892 | Medicaid | |
| OH | 2379322 | Medicaid | |
| OH | 2379304 | Medicaid | |
| OH | 2712872 | Medicaid | |
| OH | 2712872 | Medicaid | |
| OH | 2379322 | Medicaid | |
| OH | 9333354 | Medicare PIN | |
| OH | 9359684 | Medicare PIN | |
| OH | 2286771 | Medicaid | |
| OH | HA4269411 | Medicare PIN | |
| OH | 9333356 | Medicare PIN | |
| OH | 0675948 | Medicare PIN | |
| OH | 9333351 | Medicare PIN | |
| OH | 9359686 | Medicare PIN | |
| OH | 9359684 | Medicare PIN |
