Organization · NPI-2
Alliance Medical Group, LLC
Family Medicine · Meridian, ID
NPI number1407092794
StatusActive
Last updated in NPPESFeb 17, 2025
Details
- NPI
- 1407092794
- Entity type
- Organization (NPI-2)
- Legal business name
- Alliance Medical Group, LLC
- Organization subpart
- No
- Enumeration date
- Dec 17, 2008
- Certification date
- Feb 17, 2025
- Last updated
- Feb 17, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Primary Health Medical Group (Doing Business As)
Practice location
1648 Nw 1st StreetMeridian, ID 83642
Phone 208-888-9393 · Fax 208-888-9525
Mailing address
Po Box 191050Boise, ID 83719-1050
Phone 208-955-6500 · Fax 208-955-6503
Authorized official
Linda Barnes
Credentialing Manager
2089851423
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