Provider Demographics
NPI:1740224054
Name:ALLIANCE MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-271-8704
Mailing Address - Street 1:42104 N VENTURE DR
Mailing Address - Street 2:SUITE D 118
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3823
Mailing Address - Country:US
Mailing Address - Phone:623-505-6565
Mailing Address - Fax:623-505-6565
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:SUITE D118
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:623-505-6565
Practice Address - Fax:623-551-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty