Provider Demographics
NPI:1518418862
Name:ALLIANCE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CENTER, INC.
Other - Org Name:AMC WINDSOR DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-385-2306
Mailing Address - Street 1:8499 OLD REDWOOD HWY
Mailing Address - Street 2:SUITE 111 & 112
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8056
Mailing Address - Country:US
Mailing Address - Phone:707-385-2306
Mailing Address - Fax:
Practice Address - Street 1:8499 OLD REDWOOD HWY
Practice Address - Street 2:SUITE 111 & 112
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8056
Practice Address - Country:US
Practice Address - Phone:707-433-5494
Practice Address - Fax:707-433-0229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-21
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center