Physicians Alliance LC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

104-16 Issued in MO

Legal business name

PHYSICIANS ALLIANCE LC

Practice address

3241 Percy Dr
Cape Girardeau, MO 63701-4901

Phone

(573) 334-1222

Fax

(573) 334-3532

NPI assigned

Oct 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jason C Bandermann

Title

Administrator

Phone

(573) 334-1222

Specialties & licenses 2

Addresses

Other names 1

• Physicians Alliance Surgery Center Doing business as

Listed as

Physicians Alliance LC Dba Physicians Alliance Surgery CenterCCN 26C0001055

Medicare certification status

Terminated Voluntary: merger or closure, Jun 1, 2024From the Provider of Services file

Practitioners 2

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

• Adam Scott Morgan, MD

  • Otolaryngology Physician
  • Cape Girardeau, MO
  • NPI 1346234945
  NPD
• Rickey Lynn Lents, MD

  • Orthopaedic Surgery Physician
  • Cape Girardeau, MO
  • NPI 1467453670
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1649269663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 PERCY DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014901",
            "telephone_number": "573-334-1222",
            "fax_number": "573-334-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 PERCY DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014901",
            "telephone_number": "573-334-1222",
            "fax_number": "573-334-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS ALLIANCE LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-21",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "BANDERMANN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-334-1222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "104-16",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MO",
            "license": "104-16",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Alliance Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judy Annette Pfeiffer, APRN
• Elizabeth Pham, PHARMD
• Kenneth Dean Phillips Jr., MD
• Kimberly C Phillips, FNP
• Lisa Marie Phillips
• Tammy Marie Piatt, MASSAGE THERAPIST
• Danetta Faye Pierson, LCSW
• Talmage Pike III, CRNA
• Sara Marie Pilsner, NP-C
• Julie Ash Pinho

• Ambulatory Surgical Clinic/Center in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.