Provider Demographics
NPI:1265055081
Name:ALLIANCE PRIMARY CARE PLUS
Entity type:Organization
Organization Name:ALLIANCE PRIMARY CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-595-0401
Mailing Address - Street 1:PO BOX 13329
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-3329
Mailing Address - Country:US
Mailing Address - Phone:601-595-0401
Mailing Address - Fax:601-420-5299
Practice Address - Street 1:209B RIVERWIND DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5653
Practice Address - Country:US
Practice Address - Phone:601-595-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty