Basic Information
| Provider Information | |||||||||
| NPI: | 1144262650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE PULMONARY ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 E STATE ST | ||||||||
| Address2: | SUITE #240 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305966560 | ||||||||
| FaxNumber: | 3308236449 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 E STATE ST | ||||||||
| Address2: | SUITE #240 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305966560 | ||||||||
| FaxNumber: | 3308236449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | BASIT | ||||||||
| AuthorizedOfficialFirstName: | ABDUL | ||||||||
| AuthorizedOfficialMiddleName: | BASIT | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3305966560 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 35078091 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2209774 | 05 | OH | MEDICAID |