Provider Demographics
NPI:1689864811
Name:ALLIANCE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-9110
Mailing Address - Street 1:2160 APPIAN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2524
Mailing Address - Country:US
Mailing Address - Phone:510-724-9110
Mailing Address - Fax:916-239-3611
Practice Address - Street 1:2160 APPIAN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2524
Practice Address - Country:US
Practice Address - Phone:510-724-9110
Practice Address - Fax:916-239-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH6799Medicare PIN
CACD7252Medicare PIN