Provider Demographics
NPI:1013078765
Name:ALIVIO MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ALIVIO MEDICAL GROUP, INC.
Other - Org Name:AMD MEDICAL SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-448-2998
Mailing Address - Street 1:3009 K ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5223
Mailing Address - Country:US
Mailing Address - Phone:916-448-2998
Mailing Address - Fax:916-448-3199
Practice Address - Street 1:3009 K ST STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5223
Practice Address - Country:US
Practice Address - Phone:916-448-2998
Practice Address - Fax:916-448-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42657174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49059Medicare UPIN