Provider Demographics
NPI:1659513901
Name:ALLIANCE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:FESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-299-8000
Mailing Address - Street 1:1009 OAK HILL RD FL 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3869
Mailing Address - Country:US
Mailing Address - Phone:925-299-8000
Mailing Address - Fax:
Practice Address - Street 1:1009 OAK HILL RD FL 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3869
Practice Address - Country:US
Practice Address - Phone:925-299-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39876261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care