Provider Demographics
NPI:1306128608
Name:ALLIANCE PHYSICIANS INC
Entity type:Organization
Organization Name:ALLIANCE PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-558-3223
Mailing Address - Street 1:10050 INNOVATION DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4931
Mailing Address - Country:US
Mailing Address - Phone:937-558-3208
Mailing Address - Fax:937-558-3247
Practice Address - Street 1:10 SOUTHMOOR CIR NW
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2486
Practice Address - Country:US
Practice Address - Phone:937-294-1489
Practice Address - Fax:937-297-6468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE PHYSICIAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059480Medicaid
OH0059480Medicaid