Provider Demographics
NPI:1760611925
Name:ALLIANCE HEALTH SERVICES S.C.
Entity Type:Organization
Organization Name:ALLIANCE HEALTH SERVICES S.C.
Other - Org Name:RIVERLAKES PAIN AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FOLLANSBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-200-2700
Mailing Address - Street 1:1370 PABST FARMS CIR
Mailing Address - Street 2:SUITE #340
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4879
Mailing Address - Country:US
Mailing Address - Phone:262-200-2700
Mailing Address - Fax:262-200-2702
Practice Address - Street 1:1370 PABST FARMS CIR
Practice Address - Street 2:SUITE #340
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4879
Practice Address - Country:US
Practice Address - Phone:262-200-2700
Practice Address - Fax:262-200-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty