Provider Demographics
NPI:1851624795
Name:ALLIANCE HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:ALLIANCE HEALTH PARTNERS, LLC
Other - Org Name:TRI-LAKES PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 731804
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1084
Mailing Address - Country:US
Mailing Address - Phone:662-563-5611
Mailing Address - Fax:662-563-0155
Practice Address - Street 1:435 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3001
Practice Address - Country:US
Practice Address - Phone:662-563-7873
Practice Address - Fax:662-563-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013323Medicaid
MS09409733Medicaid
MS258516Medicare PIN