Provider Demographics
NPI:1841556727
Name:ALLIANCE PHYSICIANS INC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICIANS INC
Other - Org Name:LIBERTY POINTE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-588-3208
Mailing Address - Street 1:7117 DUTCHLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9096
Mailing Address - Country:US
Mailing Address - Phone:513-261-6530
Mailing Address - Fax:513-261-6532
Practice Address - Street 1:2110 LEITER RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3660
Practice Address - Country:US
Practice Address - Phone:937-384-4838
Practice Address - Fax:937-384-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063232Medicaid
OH0063232Medicaid