Healthcare Provider Details

I. General information

NPI: 1619201043
Provider Name (Legal Business Name): ALLIANCE HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MEDICAL CENTER DR
BATESVILLE MS
38606-8608
US

IV. Provider business mailing address

303 MEDICAL CENTER DR
BATESVILLE MS
38606-8608
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-5611
  • Fax: 662-563-0155
Mailing address:
  • Phone: 662-563-5611
  • Fax: 662-563-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13-287
License Number StateMS

VIII. Authorized Official

Name: DR. MICHAEL R. HAVENS
Title or Position: CEO
Credential: M. D.
Phone: 662-563-5611