Provider Demographics
NPI:1558535161
Name:ALLIANCE PRIMARY CARE
Entity Type:Organization
Organization Name:ALLIANCE PRIMARY CARE
Other - Org Name:UNIVERSITY FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR
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:513-585-9009
Mailing Address - Fax:513-585-9373
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SU. 3100
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-8264
Practice Address - Fax:513-475-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2708323Medicaid
KY65929291Medicaid
OHAL9292397Medicare PIN