Provider Demographics
NPI:1700270139
Name:ALLIANCE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-300-6278
Mailing Address - Street 1:6245 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3964
Mailing Address - Country:US
Mailing Address - Phone:954-613-4715
Mailing Address - Fax:954-613-4722
Practice Address - Street 1:6245 MIRAMAR PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3964
Practice Address - Country:US
Practice Address - Phone:954-613-4715
Practice Address - Fax:954-613-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268377600Medicaid