Provider Demographics
NPI:1891865366
Name:ALLIANCE NEUROLOGICAL CENTER INC
Entity Type:Organization
Organization Name:ALLIANCE NEUROLOGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-829-9389
Mailing Address - Street 1:270 E STATE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4957
Mailing Address - Country:US
Mailing Address - Phone:330-823-4044
Mailing Address - Fax:330-829-9372
Practice Address - Street 1:1914 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4355
Practice Address - Country:US
Practice Address - Phone:330-829-9389
Practice Address - Fax:330-829-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047526S2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0511066Medicaid
OH0518493Medicare ID - Type Unspecified
OHA15219Medicare UPIN