Provider Demographics
NPI:1821143256
Name:ALLIANCE HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE SYSTEM INC
Other - Org Name:WILLIAMS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-252-1599
Mailing Address - Street 1:1938 CRESCENT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-7419
Mailing Address - Country:US
Mailing Address - Phone:662-252-1599
Mailing Address - Fax:662-252-1986
Practice Address - Street 1:1938 CRESCENT MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-7419
Practice Address - Country:US
Practice Address - Phone:662-252-1599
Practice Address - Fax:662-252-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013693Medicaid
MS09013693Medicaid
MSC03243Medicare PIN
MS258529Medicare PIN