NPIMap

Organization Active NPI

Alliance Healthcare System, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Holly Springs, MS
National Provider Identifier
1710177381
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
ALLIANCE HEALTHCARE SYSTEM, INC
Practice address
1430 Highway 4 E
Holly Springs, MS 38635-2140
Phone
(662) 252-1212
NPI assigned
Jul 30, 2007
Last updated
May 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIANCE HEALTHCARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Authorized official

Name
Perry E Williams Sr.
Title
Administrator
Phone
(662) 252-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

1430 Highway 4 E
Holly Springs, MS 38635-2140

Mailing address

1430 Highway 4 E
Post Ofice Drawer 6000
Holly Springs, MS 38635-2140
Phone (662) 252-1212

Other identifiers 1

IdentifierTypeStateIssuer
00220517MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240524001788 MS Part A Provider - Hospital 2961489547 Practice locations: Holly Springs, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710177381. Details of each certification follow.

Hospital certification: CCN 25U174

Legal name
ALLIANCE HEALTHCARE SYSTEM, INC
Organization structure
CorporationProprietary
Incorporated
Feb 1, 1989 in MS
Enrollment address
1430 Highway 4 E
Holly Springs, MS 38635-2140
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Methodist Family Med CL5 organizations share this tax ID, including this one
Part of
Marshall Med CT Marshal

Other organizations with this tax ID 4

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Regina Williams Individual Corporate DirectorNone Nov 1, 1999
Kenneth Williams Individual 5% Or Greater Direct Ownership Interest Nov 1, 1999 100%
W-2 Managing Employee Nov 1, 1999
Ethel Thompson Individual Corporate DirectorNone Nov 1, 1999

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1710177381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 HIGHWAY 4 E",
            "address_2": "POST OFICE DRAWER 6000",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352140",
            "telephone_number": "662-252-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 HIGHWAY 4 E",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352140",
            "telephone_number": "662-252-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIANCE HEALTHCARE SYSTEM",
        "enumeration_date": "2007-07-30",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-252-1212",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220517",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Springs, MS

Sources for this page

Verify at the official NPI Registry.