Provider Demographics
NPI:1184878753
Name:MEDICAL ALLIANCE CLINIC, PLLC
Entity type:Organization
Organization Name:MEDICAL ALLIANCE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-437-8158
Mailing Address - Street 1:505 W FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3923
Mailing Address - Country:US
Mailing Address - Phone:828-437-8158
Mailing Address - Fax:828-438-9552
Practice Address - Street 1:505 W FLEMING DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3923
Practice Address - Country:US
Practice Address - Phone:828-437-8158
Practice Address - Fax:828-438-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94007532084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130GNOtherBCBS
NC5911795Medicaid
NCG48095Medicare UPIN
NC2236401GMedicare PIN