Basic Information
| Provider Information | |||||||||
| NPI: | 1518418862 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMC WINDSOR DENTAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8499 OLD REDWOOD HWY | ||||||||
| Address2: | SUITE 111 & 112 | ||||||||
| City: | WINDSOR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954928056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073852306 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8499 OLD REDWOOD HWY | ||||||||
| Address2: | SUITE 111 & 112 | ||||||||
| City: | WINDSOR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954928056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074335494 | ||||||||
| FaxNumber: | 7074330229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2016 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHURCHILL | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7073852306 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALLIANCE MEDICAL CENTER, INC. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.