Provider Demographics
NPI:1760989347
Name:ALLIANCE MEDICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:833-822-0100
Mailing Address - Street 1:7450 CHATEAU RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-7545
Mailing Address - Country:US
Mailing Address - Phone:951-858-5439
Mailing Address - Fax:800-343-2107
Practice Address - Street 1:3500 LENOX RD NE STE 1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-4231
Practice Address - Country:US
Practice Address - Phone:833-822-0010
Practice Address - Fax:800-343-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
293D00000X
CA335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory