Provider Demographics
NPI:1285096388
Name:ALLIANCE INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:ALLIANCE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-254-9330
Mailing Address - Street 1:70 PARKWAY COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5213
Mailing Address - Country:US
Mailing Address - Phone:864-254-9330
Mailing Address - Fax:864-254-9370
Practice Address - Street 1:70 PARKWAY COMMONS WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5213
Practice Address - Country:US
Practice Address - Phone:864-254-9330
Practice Address - Fax:864-254-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19254302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC207R00000XOtherTAXONOMY CODE
SC207R00000XOtherTAXONOMY CODE