Basic Information
| Provider Information | |||||||||
| NPI: | 1699929562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE COMMUNITY MEDICAL FOUNDATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446014936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308299389 | ||||||||
| FaxNumber: | 3308299372 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446014936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305966570 | ||||||||
| FaxNumber: | 3308298689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | GEIGER | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3305967528 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
ID Information
| ID | Type | State | Issuer | Description | 2866788 | 05 | OH | MEDICAID |