NPIMap

Alliance Medical Group, LLC

Organization Active NPI Family Medicine Physician · Meridian, ID

NPI 1407092794 · NPPES record last updated Feb 17, 2025

Key facts

NPI
1407092794
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
ALLIANCE MEDICAL GROUP, LLC
Practice address
1648 NW 1St Street
Meridian, ID 83642
Phone
(208) 888-9393
Fax
(208) 888-9525
NPI assigned
Dec 17, 2008
Organization subpart
No

Authorized official

Name
Linda Barnes
Title
Credentialing Manager
Phone
(208) 985-1423

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 132

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 132

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0861110Primary Health Medical Group - Meridian
1648 NW 1St Street, Meridian, ID 83642		Provider-performed microscopySep 8, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ID

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20111017000539 ID DME Supplier - Physician - General Practice 3971544685 Practice locations: Meridian, ID

National Provider Directory

Tax ID family
Alliance Medical Group LLC (17 organizations share this tax ID)

Locations

1648 NW 1st St
Meridian, ID 83642
Phone (208) 888-9393

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

1648 NW 1St Street
Meridian, ID 83642

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500

Other names

  • Primary Health Medical Group Doing business as

Other providers in Meridian, ID

All providers in Meridian, ID · Family Medicine Physician in Idaho

Sources for this page

Verify at the official NPI Registry.