Provider Demographics
NPI:1386620037
Name:ALLIANCE MEDICAL, INC.
Entity type:Organization
Organization Name:ALLIANCE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-983-5644
Mailing Address - Street 1:707 ALBEMARLE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-8681
Mailing Address - Country:US
Mailing Address - Phone:910-572-2117
Mailing Address - Fax:910-572-5185
Practice Address - Street 1:707 ALBEMARLE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-8681
Practice Address - Country:US
Practice Address - Phone:910-572-2117
Practice Address - Fax:910-572-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00285332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703871Medicaid
NC6600932Medicaid
NC7795170Medicaid
0487QOtherBCBS OF NC PROVIDER NUMBE
NC0436460002Medicare ID - Type Unspecified