NPIMap

Organization Active NPI

Alliance Healthcare System Inc

Doing business as Williams Medical Clinic of Potts Camp

  • Rural Health Clinic/Center
  • Potts Camp, MS
National Provider Identifier
1851446033
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALLIANCE HEALTHCARE SYSTEM INC
Doing business as
Williams Medical Clinic of Potts Camp
Practice address
39 South Center Street
Potts Camp, MS 38659
Phone
(662) 333-6933
Fax
(662) 333-6931
NPI assigned
Jan 25, 2007
Last updated
Mar 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Kenneth Williams, MDNPI 1851480974
Title
Owner
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
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

39 South Center Street
Potts Camp, MS 38659

Mailing address

39 Center Street
Potts Camp, MS 38659
Phone (662) 333-6933

Other identifiers 1

IdentifierTypeStateIssuer
09013973MedicaidMS

Other names 1

  • WILLIAMS MEDICAL CLINIC OF POTTS CAMP Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851446033. Details of each certification follow.

Rural health clinic certification: CCN 258529

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WILLIAMS MEDICAL CLINIC OF POTTS CAMP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2006
Last certification
Aug 21, 2018
Ownership / control type
1B
Facility address
39 Center St Box 40
Potts Camp, MS 38659
Related CCNs
250012

National Provider Directory

National Provider Directory

Member of 1

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

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": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1851446033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 CENTER STREET",
            "city": "POTTS CAMP",
            "state": "MS",
            "postal_code": "38659",
            "telephone_number": "662-333-6933",
            "fax_number": "662-333-6931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 SOUTH CENTER STREET",
            "city": "POTTS CAMP",
            "state": "MS",
            "postal_code": "38659",
            "telephone_number": "662-333-6933",
            "fax_number": "662-333-6931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTHCARE SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-252-1599",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013973",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLIAMS MEDICAL CLINIC OF POTTS CAMP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potts Camp, MS

Sources for this page

Verify at the official NPI Registry.