NPIMap

Organization Active NPI

Alliance Physician Inc

Doing business as Kettering Medical Center - Breast Evaluation Center

  • Surgical Physician Assistant
  • Kettering, OH
National Provider Identifier
1891077293
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
ALLIANCE PHYSICIAN INC
Doing business as
Kettering Medical Center - Breast Evaluation Center
Practice address
3535 Southern Blvd
Suite B
Kettering, OH 45429-1221
Phone
(937) 298-4331
NPI assigned
Sep 13, 2011
Last updated
Sep 13, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIANCE PHYSICIAN INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

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

Authorized official

Name
Daniel D Haibach
Title
Director Business Development
Phone
(937) 914-7094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

3535 Southern Blvd
Suite B
Kettering, OH 45429-1221

Mailing address

2110 Leiter Rd
Miamisburg, OH 45342-3660
Phone (937) 384-4838

Other identifiers 1

IdentifierTypeStateIssuer
2712872MedicaidOH

Other names 1

  • Kettering Medical Center - Breast Evaluation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Family Practi77 organizations share this tax ID, including this one
Part of
Northeast Family Practi

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

3535 Southern Blvd
Ste B
Kettering, OH 45429
Phone (937) 298-4331

NPI Registry JSON

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1891077293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423660",
            "telephone_number": "937-384-4838",
            "fax_number": "937-384-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "address_2": "SUITE B",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-298-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE PHYSICIAN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIANCE PHYSICIAN INC",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "HAIBACH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "937-914-7094"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2712872",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettering Medical Center - Breast Evaluation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.