Provider Demographics
NPI:1609423284
Name:ALLIANCE MEDICAL CARE CENTERS
Entity type:Organization
Organization Name:ALLIANCE MEDICAL CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-595-9958
Mailing Address - Street 1:2649 FLAMINGO LN
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4759
Mailing Address - Country:US
Mailing Address - Phone:210-595-9958
Mailing Address - Fax:
Practice Address - Street 1:2649 FLAMINGO LN
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4759
Practice Address - Country:US
Practice Address - Phone:210-595-9958
Practice Address - Fax:210-547-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing