Basic Information
| Provider Information | |||||||||
| NPI: | 1417176207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE HEALTHCARE SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005443215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 S GRAND AVE | ||||||||
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| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917414218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269638411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 10/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | POAN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0208X | 6640-30 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
ID Information
| ID | Type | State | Issuer | Description | 470001394 | 01 | CA | RAILROAD MEDICARE | OTHER | 470000284 | 01 | CA | RAILROAD MEDICARE | OTHER | IDTF00740 | 05 | CA | MEDICAID |