Provider Demographics
NPI:1134314859
Name:ALLIANCE HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:662-252-1212
Mailing Address - Street 1:9305 STATE LINE RD
Mailing Address - Street 2:11-G
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3727
Mailing Address - Country:US
Mailing Address - Phone:662-252-1672
Mailing Address - Fax:
Practice Address - Street 1:1430 HIGHWAY 4 E
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-2140
Practice Address - Country:US
Practice Address - Phone:662-252-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16252282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital