Provider Demographics
NPI:1700889680
Name:ALLIANCE MEDICAL, INC.
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRIEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-571-4333
Mailing Address - Street 1:146 E 13065 S
Mailing Address - Street 2:STE F
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8674
Mailing Address - Country:US
Mailing Address - Phone:801-571-4333
Mailing Address - Fax:801-571-4355
Practice Address - Street 1:146 E 13065 S
Practice Address - Street 2:STE F
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8674
Practice Address - Country:US
Practice Address - Phone:801-571-4333
Practice Address - Fax:801-571-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========01001OtherBCBS OF UTAH
UT=========003Medicaid
UT=========01001OtherBCBS OF UTAH