Provider Demographics
NPI:1508039074
Name:ALLIANCE PRIMARY CARE
Entity Type:Organization
Organization Name:ALLIANCE PRIMARY CARE
Other - Org Name:TRISTATE SURGICAL WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-585-9336
Mailing Address - Street 1:3200 BURNET AVE
Mailing Address - Street 2:1 RIDGEWAY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-9305
Mailing Address - Fax:513-585-6146
Practice Address - Street 1:7380 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1355
Practice Address - Country:US
Practice Address - Phone:859-212-4625
Practice Address - Fax:859-212-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2270028Medicaid
KY2270028Medicaid