| Alliance Medical Group, Llc | |
|
512 N 21st Ave Caldwell ID 83605-4368 | |
| (208) 985-2875 | |
| (208) 985-2876 |
| Full Name | Alliance Medical Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 512 N 21st Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Trisha Nauman (CREDENTIALING MANAGER) |
| Authorized Official Contact | 2089556522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alliance Medical Group, Llc Po Box 191050 Boise ID 83719-1050 Ph: (208) 955-6522 | Alliance Medical Group, Llc 512 N 21st Ave Caldwell ID 83605-4368 Ph: (208) 985-2875 |
| NPI Number | 1073079463 |
|---|---|
| Provider Enumeration Date | 02/11/2019 |
| Last Update Date | 02/11/2019 |
| Medicare PECOS PAC ID | 3971544685 |
|---|---|
| Medicare Enrollment ID | O20190509002527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073079463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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