Provider Demographics
NPI:1639343247
Name:ALLIANCE PRIMARY CARE
Entity type:Organization
Organization Name:ALLIANCE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-585-9336
Mailing Address - Street 1:3200 BURNET AVE
Mailing Address - Street 2:1 RIDGEWAY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-9009
Mailing Address - Fax:513-585-9373
Practice Address - Street 1:3131 HARVEY AVE
Practice Address - Street 2:STE. 104
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3000
Practice Address - Country:US
Practice Address - Phone:513-585-9500
Practice Address - Fax:513-585-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034284Medicaid
OHAL9292314Medicare PIN