Provider Demographics
NPI:1699328146
Name:ALLIANCE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ALLIANCE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:INGLIS
Authorized Official - Last Name:WOLLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-252-1228
Mailing Address - Street 1:3663 N COUNTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4587
Mailing Address - Country:US
Mailing Address - Phone:231-252-1228
Mailing Address - Fax:
Practice Address - Street 1:3663 NORTH COUNTRY DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4587
Practice Address - Country:US
Practice Address - Phone:231-499-4419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical