Provider Demographics
NPI:1508936824
Name:ALLIANCE MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-762-3741
Mailing Address - Street 1:2307 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-4437
Mailing Address - Country:US
Mailing Address - Phone:308-762-3741
Mailing Address - Fax:308-762-7743
Practice Address - Street 1:2307 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4437
Practice Address - Country:US
Practice Address - Phone:308-762-3741
Practice Address - Fax:308-762-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid