Alliance Physician Services Pllc | |
4004 Harcourt Ln Richmond VA 23233-1776 | |
(804) 824-5981 | |
Not Available |
Full Name | Alliance Physician Services Pllc |
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Speciality | Clinic/Center |
Location | 4004 Harcourt Ln, Richmond, Virginia |
Authorized Official Name and Position | Jessie Burnett (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 8043785010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Alliance Physician Services Pllc 4004 Harcourt Ln Richmond VA 23233-1776 Ph: (804) 378-5010 | Alliance Physician Services Pllc 4004 Harcourt Ln Richmond VA 23233-1776 Ph: (804) 824-5981 |
NPI Number | 1497245500 |
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Provider Enumeration Date | 05/14/2018 |
Last Update Date | 02/27/2019 |
Medicare PECOS PAC ID | 3779829577 |
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Medicare Enrollment ID | O20190116000922 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497245500 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 0101226169 (Virginia) | Primary |
Provider Name | Joel E Backer |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811952393 PECOS PAC ID: 3173578762 Enrollment ID: I20050316000752 |
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