Basic Information
| Provider Information | |||||||||
| NPI: | 1437313475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE PULMONARY ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2749 | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446010749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308299389 | ||||||||
| FaxNumber: | 3308299372 | ||||||||
| Practice Location | |||||||||
| Address1: | 5860 LOUISVILLE STREET NE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308217400 | ||||||||
| FaxNumber: | 3308236449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 07/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | BASIT | ||||||||
| AuthorizedOfficialFirstName: | ABDUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3308217400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |