Provider Demographics
NPI:1497844161
Name:FAMILY MEDICAL CENTER OF ALLIANCE, INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF ALLIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGI
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-823-3856
Mailing Address - Street 1:149 E SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4219
Mailing Address - Country:US
Mailing Address - Phone:330-823-3856
Mailing Address - Fax:330-829-6688
Practice Address - Street 1:149 E SIMPSON ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4219
Practice Address - Country:US
Practice Address - Phone:330-823-3856
Practice Address - Fax:330-829-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH335551Medicaid
OHCB3053OtherMEDICARE RR
OH335551Medicaid