Provider Demographics
NPI:1700181021
Name:ALLIANCE MEDICAL CARE GROUP LLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSOCIATE / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PA
Authorized Official - Phone:954-450-7998
Mailing Address - Street 1:9869 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6100
Mailing Address - Country:US
Mailing Address - Phone:954-450-7998
Mailing Address - Fax:954-450-9991
Practice Address - Street 1:9869 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6100
Practice Address - Country:US
Practice Address - Phone:954-450-7998
Practice Address - Fax:954-450-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty