Provider Demographics
NPI:1871522581
Name:INTERNATIONAL MEDICAL ALLIANCE
Entity type:Organization
Organization Name:INTERNATIONAL MEDICAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LARRRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-452-6682
Mailing Address - Street 1:8550 EAST DESERT INN ROAD
Mailing Address - Street 2:#311
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8550 EAST DESERT INN ROAD
Practice Address - Street 2:#311
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:98121
Practice Address - Country:US
Practice Address - Phone:916-452-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID