NPIMap

Organization Active NPI

Alliance Healthcare System

  • Nurse Practitioner
  • Holly Springs, MS
National Provider Identifier
1609973056
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ALLIANCE HEALTHCARE SYSTEM
Practice address
538 J. M. Ash Rd.
Holly Springs, MS 38635-3238
Phone
(662) 252-1599
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Richard Goodman Wiseman, FNPNPI 1871690263
Title
Employee
Phone
(662) 252-1599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

538 J. M. Ash Rd.
Holly Springs, MS 38635-3238

Mailing address

538 Ash Rd.
Holly Springs, MS 38635-5040
Phone (662) 252-1599

Other identifiers 1

IdentifierTypeStateIssuer
00114188MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
WMC Pharmacy13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

538 J M Ash Dr
Holly Springs, MS 38635
Phone (662) 252-1599

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609973056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 ASH RD.",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386355040",
            "telephone_number": "662-252-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 J. M. ASH RD.",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386353238",
            "telephone_number": "662-252-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WISEMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "GOODMAN",
        "authorized_official_title_or_position": "EMPLOYEE",
        "authorized_official_telephone_number": "662-252-1599",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114188",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Springs, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.