Healthcare Provider Details

I. General information

NPI: 1851446033
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SOUTH CENTER STREET
POTTS CAMP MS
38659
US

IV. Provider business mailing address

39 CENTER STREET
POTTS CAMP MS
38659
US

V. Phone/Fax

Practice location:
  • Phone: 662-333-6933
  • Fax: 662-333-6931
Mailing address:
  • Phone: 662-333-6933
  • Fax: 662-333-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 662-252-1599